Provider Demographics
NPI:1043821424
Name:KING, MEGAN (FNP-BC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SMITH DR
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:NY
Mailing Address - Zip Code:12822-1341
Mailing Address - Country:US
Mailing Address - Phone:518-654-7680
Mailing Address - Fax:518-654-7693
Practice Address - Street 1:200 SMITH DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822-1341
Practice Address - Country:US
Practice Address - Phone:518-654-7680
Practice Address - Fax:518-654-7693
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN345963-01363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care