Provider Demographics
NPI:1972936599
Name:KING, ELLA (MS, FNP-BC, RN)
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MS, FNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 POLARIS PKWY
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7971
Mailing Address - Country:US
Mailing Address - Phone:614-545-7900
Mailing Address - Fax:614-545-7901
Practice Address - Street 1:605 CRESCENT PL
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-3086
Practice Address - Country:US
Practice Address - Phone:614-545-7900
Practice Address - Fax:614-545-7901
Is Sole Proprietor?:No
Enumeration Date:2013-08-19
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.14915-NP363LF0000X
OHCNP.14915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily