Mary Jane King
Individual provider Active NPI Licensed Practical Nurse · Mapaville, MO
NPI 1386477834 · NPPES record last updated Aug 21, 2024
Key facts
- NPI
- 1386477834
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Licensed Practical Nurse 164W00000X
- License
- 2001004925 (MO)
- Practice address
- 3657 Baptist Park Rd
Mapaville, MO 63065 - Phone
- (636) 931-0080
- NPI assigned
- Aug 21, 2024
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2001004925 | MO | MD | Licensed Practical Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | 2001004925 | MO | Yes |
Addresses
Primary practice location
3657 Baptist Park Rd
Mapaville, MO 63065
Mailing address
565 Wall St
Herculaneum, MO 63048-1126
Phone (573) 701-6748
Other providers in Mapaville, MO
- Jefferson County Developmental Disbilities Resource Board
- Nancy Lynn Menke
- Lauryn E Morris
- Nextstep for Life, Inc.
- Pony Bird Incorporated
- Pony Bird Incorporated
All providers in Mapaville, MO · Licensed Practical Nurse in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.