Mark S King, MD, PA

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

E5875 Issued in AR

Legal business name

MARK S KING, MD, PA

Doing business as

King Dermatology

Practice address

2062 Highway 62 W
Mountain Home, AR 72653-7656

Phone

(870) 425-5464

Fax

(870) 425-5465

NPI assigned

Jul 16, 2009

Organization subpart

No

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

Authorized official

Name

Mark Steven King, M.D.NPI 1891882072

Title

Owner

Phone

(870) 425-5464

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• King Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in AR2 enrollments

Enrollment records 2

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Steven King, M.D.

  • Dermatology Physician
  • Mountain Home, AR
  • NPI 1891882072
  Medicare reassignment Care Compare group NPD Authorized official
• Lonnie M Hammonds Jr., M.D.

  • Dermatology Physician
  • Mountain Home, AR
  • NPI 1356464838
  Medicare reassignment Care Compare group NPD
• Maegan Lynn Wagner, ANP

  • Family Nurse Practitioner
  • Mountain Home, AR
  • NPI 1871935049
  Medicare reassignment Care Compare group NPD
• Heather Celest Hammonds, M.D.

  • Sports Medicine (Family Medicine) Physician
  • Mountain Home, AR
  • NPI 1063685816
  Medicare reassignment Care Compare group
• Kelly Marie Krause, PA-C

  • Physician Assistant
  • Mountain Home, AR
  • NPI 1487063897
  Medicare reassignment Care Compare group
• Kelli Michele Camp, DNP, APN, FNP-BC

  • Family Nurse Practitioner
  • Mountain Home, AR
  • NPI 1790068773
  NPD (past)

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

{
    "created_epoch": "1247702400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1661299200000",
    "number": "1619107398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 763",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726540763",
            "telephone_number": "870-425-5464",
            "fax_number": "870-425-5465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2062 HIGHWAY 62 W",
            "city": "MOUNTAIN HOME",
            "state": "AR",
            "postal_code": "726537656",
            "telephone_number": "870-425-5464",
            "fax_number": "870-425-5465"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK S KING, MD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-16",
        "last_updated": "2022-08-24",
        "certification_date": "2022-08-24",
        "status": "A",
        "authorized_official_last_name": "KING",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "STEVEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "870-425-5464",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "AR",
            "license": "E5875",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "179411002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "King Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brian Imbao Malte, M.D.
• Helen L Mansfield
• Maysa Linn Mansfield
• Michelle Lynn Marcak, APRN
• Greg Mardis
• Jeanne Marotta, CNP
• Lyndsey Marriott
• Megan Nicole Martin
• Sara Rebecca Martin, M.D.
• Jaclyn Renee Martinez

• Dermatology Physician in Mountain Home, AR
• Providers in Mountain Home, AR by specialty
• Dermatology Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.