Basic Information
| Provider Information | |||||||||
| NPI: | 1073000345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | JEREMY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MSN, ARNP, FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4061 NE 110TH ST | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981255806 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2063906614 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 330 S STILLAGUAMISH AVE | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982231642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604352133 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/22/2018 | ||||||||
| LastUpdateDate: | 09/25/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN00129188 | WA | N | Nursing Service Providers | Registered Nurse | 363L00000X | AP60898522 | WA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.