Provider Demographics
NPI:1699170480
Name:KING, DANIELLE RAYMONDE (ANP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:RAYMONDE
Last Name:KING
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:DANIELLE
Other - Middle Name:RAYMONDE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:2249 STATE ROUTE 86 STE 3
Practice Address - Street 2:
Practice Address - City:SARANAC LAKE
Practice Address - State:NY
Practice Address - Zip Code:12983-5646
Practice Address - Country:US
Practice Address - Phone:518-891-3845
Practice Address - Fax:518-891-1236
Is Sole Proprietor?:No
Enumeration Date:2014-10-23
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF421176363LW0102X
NYF307105363LA2200X
NY307105363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04039158Medicaid
NY01995615 GROUPMedicaid