Provider Demographics
NPI:1720806326
Name:KING, HOLLY BETH (PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:HOLLY
Middle Name:BETH
Last Name:KING
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13 WHEELER CT
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-6262
Mailing Address - Country:US
Mailing Address - Phone:314-707-9497
Mailing Address - Fax:
Practice Address - Street 1:2935 KAUFMANN AVE
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-1656
Practice Address - Country:US
Practice Address - Phone:563-556-0673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-01
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG182051363LP0808X
MO2024031590363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health