Provider Demographics
NPI:1528107455
Name:KING, KATHRYN JONES (MD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:JONES
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S HUGHES BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-4785
Mailing Address - Country:US
Mailing Address - Phone:252-562-6411
Mailing Address - Fax:252-562-6645
Practice Address - Street 1:615 S HUGHES BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-4785
Practice Address - Country:US
Practice Address - Phone:252-562-6411
Practice Address - Fax:252-562-6645
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31310208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8947144Medicaid
NC8947144Medicaid