Provider Demographics
NPI:1699875534
Name:KING, NANCY (RD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:KING
Other - Last Name:MCLAURIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:1005 MAR WALT DRIVE
Mailing Address - Street 2:INTERNAL MEDICINE DEPARTMENT
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6707
Mailing Address - Country:US
Mailing Address - Phone:850-863-8100
Mailing Address - Fax:850-862-6148
Practice Address - Street 1:1005 MAR WALT DRIVE
Practice Address - Street 2:INTERNAL MEDICINE DEPARTMENT
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6707
Practice Address - Country:US
Practice Address - Phone:850-863-8100
Practice Address - Fax:850-862-6148
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
FLND5325133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133N00000XDietary & Nutritional Service ProvidersNutritionist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00461299OtherDIETETIC REGISTRATION