Koretta A King

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

90647 Issued in NC

Practice address

152 Queensberry CT
Greensboro, NC 27405-4899

Phone

(336) 254-3867

NPI assigned

Oct 31, 2020

Last updated

Oct 31, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Koretta King Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Five Mile Family Services LLC

  • Assisted Living Facility (Mental Illness)
  • Greensboro, NC
  • NPI 1861386468
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604102400000",
    "number": "1194325746",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "152 QUEENSBERRY CT",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274054899",
            "telephone_number": "336-254-3867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "152 QUEENSBERRY CT",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274054899",
            "telephone_number": "336-254-3867"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "KORETTA",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-31",
        "last_updated": "2020-10-31",
        "certification_date": "2020-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NC",
            "license": "90647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "allthellvenursing@yahoo.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "allthelovenursing@yahoo.com",
            "address_1": "152 Queensberry Ct",
            "city": "Greensboro",
            "state": "NC",
            "country_code": "US",
            "postal_code": "274054899",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KORETTA",
            "last_name": "KING",
            "credential": "LPN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Deirdre Michelle King, MSW, P-LCSW
• Dora King
• Elizabeth Anne Meade King, PHARMD.
• Jacy King, LCMHCA
• John Haskins King, PHD, LPC, LMFT, NCC
• Kristen Anne King, PH.D.
• Larisa King
• Latisha King
• Laura King, RD, LDN
• Lindsey King, RN

• Licensed Practical Nurse in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Licensed Practical Nurse in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.