Provider Demographics
NPI:1528699675
Name:KING, PHILICIA J (PMHNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:PHILICIA
Middle Name:J
Last Name:KING
Suffix:
Gender:F
Credentials:PMHNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2573 STATE HIGHWAY 522
Mailing Address - Street 2:
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87556
Mailing Address - Country:US
Mailing Address - Phone:575-586-0315
Mailing Address - Fax:
Practice Address - Street 1:1300 EL PASEO RD STE 244
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6024
Practice Address - Country:US
Practice Address - Phone:575-448-7119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM65770363LP0808X
VA0024178413363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily