Provider Demographics
NPI:1174381503
Name:KING, JACQUELINE M (APRN-CNP)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:M
Last Name:KING
Suffix:
Gender:
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:MARIE
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-3069
Mailing Address - Fax:614-293-3332
Practice Address - Street 1:1800 ZOLLINGER RD FL 4
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2800
Practice Address - Country:US
Practice Address - Phone:614-293-3069
Practice Address - Fax:614-293-3332
Is Sole Proprietor?:No
Enumeration Date:2024-03-11
Last Update Date:2025-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.497736163WW0101X
OHAPRN.CNP.0036712363L00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner