Provider Demographics
NPI:1598865511
Name:KING, HEATHER TEMPLE (CFNP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:TEMPLE
Last Name:KING
Suffix:
Gender:F
Credentials:CFNP
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Other - Last Name:
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Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:DIVISION OF INFECTIOUS DISEASE
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-984-6426
Mailing Address - Fax:601-984-6439
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:DEPARTMENT OF MEDICINE DIVISION OF INFECTIOUS DISEASE
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5560
Practice Address - Fax:601-984-5565
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR865791363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08884077Medicaid
MS302I503854Medicare PIN
MS08884077Medicaid