Provider Demographics
NPI:1710795257
Name:KING, JOSEPH JEFFERY (FNP-C)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JEFFERY
Last Name:KING
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 424
Mailing Address - Street 2:
Mailing Address - City:TEHACHAPI
Mailing Address - State:CA
Mailing Address - Zip Code:93581-0424
Mailing Address - Country:US
Mailing Address - Phone:661-972-8085
Mailing Address - Fax:
Practice Address - Street 1:1100 MAGELLAN DR
Practice Address - Street 2:
Practice Address - City:TEHACHAPI
Practice Address - State:CA
Practice Address - Zip Code:93561-1380
Practice Address - Country:US
Practice Address - Phone:661-823-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035569163WE0003X
CA95034131207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency