Shavanna King, PMHNP- BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

APRN11033411 Issued in FL

Practice address

1620 Corsair LN Ste 201
Middleburg, FL 32068-8558

Phone

(904) 787-8850

NPI assigned

Jun 22, 2024

Last updated

Jan 23, 2025By 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 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Livality Integrated Health

  • Psychiatric/Mental Health Nurse Practitioner
  • Middleburg, FL
  • NPI 1194507962
  NPD
• Mental Health Resource Center Inc

  • Community Health Clinic/Center
  • Jacksonville, FL
  • NPI 1851407365
  NPD (past)

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

{
    "created_epoch": "1719014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737590400000",
    "number": "1487498630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "590 CHANCELLOR DR W",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322258143",
            "telephone_number": "904-420-9724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 CORSAIR LN STE 201",
            "city": "MIDDLEBURG",
            "state": "FL",
            "postal_code": "320688558",
            "telephone_number": "904-787-8850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "SHAVANNA",
        "name_prefix": "Mrs.",
        "credential": "PMHNP- BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-22",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "FL",
            "license": "APRN11033411",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "FL",
            "license": "RN9394466",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Kevin Jordan, LDO
• Gary Kao, M.D.
• Tejas Karawadia, MD
• Matthew Kheir, MD
• Mallory King
• Joan Kingston, LCSW
• Dylan Lee Kio, PHARMD
• Elizabeth Ashlee Klanderman, DMD
• Whitney Renee Kopernik
• Betty Anne Koski, LMHC LMFT

• Psychiatric/Mental Health Nurse Practitioner in Middleburg, FL
• Providers in Middleburg, FL by specialty
• Psychiatric/Mental Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2025; 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.