Active NPI
Lisa Jennifer King, CRNP
- Nurse Practitioner
- Mansfield, OH
National Provider Identifier
1104155605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- COA.11067-NP
- Practice address
- 70 Madison Rd
Mansfield, OH 44905-2831 - Phone
- (419) 589-9700
- Fax
- (419) 589-2731
- NPI assigned
- Dec 11, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | COA.11067-NP | OH | Primary |
Addresses
Primary practice location
70 Madison Rd
Mansfield, OH 44905-2831
Mailing address
1025 S Trimble Rd
Mansfield, OH 44906-3427
Phone (419) 589-9700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160511002341 | OH | Order and Referring Only - Nurse Practitioner | 7416091368 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| COA.11067-NP | OH | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Alfred Granson Jr MD LLC | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Mansfield, OH
- NPI 1598088528
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1260489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1457395200000",
"number": "1104155605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1025 S TRIMBLE RD",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449063427",
"telephone_number": "419-589-9700",
"fax_number": "419-589-2103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "70 MADISON RD",
"city": "MANSFIELD",
"state": "OH",
"postal_code": "449052831",
"telephone_number": "419-589-9700",
"fax_number": "419-589-2731"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "LISA",
"middle_name": "JENNIFER",
"name_prefix": "Mrs.",
"credential": "CRNP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-12-11",
"last_updated": "2016-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OH",
"license": "COA.11067-NP",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mansfield, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.