Simone E King, PMHNPCE-DNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4704158711 Issued in MI

Practice address

815 Business Park Dr Ste a
Traverse City, MI 49686-8683

Phone

(925) 876-1887

NPI assigned

Oct 15, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1634256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1487317509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "815 BUSINESS PARK DR STE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868683",
            "telephone_number": "925-876-1887"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 BUSINESS PARK DR STE A",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868683",
            "telephone_number": "925-876-1887"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "SIMONE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "PMHNPCE-DNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-10-15",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95019084",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704158711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1487317509",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ccm@chronic-care.net",
            "affiliation": "N",
            "endpointDescription": "chronic care email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "815 Business Park Dr Ste A",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496868683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Allison King
• Alyssa Marie King
• Lexie Joyce King
• Marinoel King, MS,LLPC
• Shelly R King, PTA
• Madalene Paige Kinser
• Alyssa Marie Kinsey
• Shawn Ann Kintigh, NP
• Tera Shawn Kinzel, RPH
• Douglas F Kirby

• Psychiatric/Mental Health Nurse Practitioner in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.