1073686929 NPI number — ROBERT RANDALL KING MSN FNP

Table of content: ROBERT RANDALL KING MSN FNP (NPI 1073686929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073686929 NPI number — ROBERT RANDALL KING MSN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
ROBERT
Provider Middle Name:
RANDALL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN FNP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073686929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 545
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THROCKMORTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-849-0629
Provider Business Mailing Address Fax Number:
940-849-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
802 N MINTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THROCKMORTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-849-2151
Provider Business Practice Location Address Fax Number:
940-849-7141
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  572478 APN , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: D0149091 . This is a "DPS REG" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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