Provider Demographics
NPI:1992966972
Name:KING, PAMELA L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:L
Last Name:KING
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ASHLEY CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40242-3305
Mailing Address - Country:US
Mailing Address - Phone:502-423-7431
Mailing Address - Fax:
Practice Address - Street 1:727 MOUNT TABOR RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-6951
Practice Address - Country:US
Practice Address - Phone:812-945-2717
Practice Address - Fax:812-948-6512
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28065309A363LF0000X
KY3000442363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78001542Medicaid
KY78001542Medicaid
KYP400043242Medicare PIN
KYP400043237Medicare PIN
KYP400043236Medicare PIN
KYP400043240Medicare PIN
KYP400043241Medicare PIN
KYP400043239Medicare PIN