Active NPI
Jeremy King
- Emergency Registered Nurse
- Kayenta, AZ
National Provider Identifier
1770192973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Registered Nurse
- License
- R104770
- Practice address
- Hwy 160 MP 394.3
Kayenta, AZ 86033-0368 - Phone
- (928) 697-4100
- Fax
- (928) 697-4029
- NPI assigned
- Jul 24, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Registered Nurse | 163WE0003X | R104770 | AR | Primary |
Addresses
Primary practice location
Hwy 160 MP 394.3
Kayenta, AZ 86033-0368
Mailing address
PO Box 368
Kayenta, AZ 86033-0368
Phone (928) 697-4100
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R104770 | AR | MD | Emergency Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1595548800000",
"number": "1770192973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 368",
"city": "KAYENTA",
"state": "AZ",
"postal_code": "860330368",
"telephone_number": "928-697-4100",
"fax_number": "928-697-4029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "HWY 160 MP 394.3",
"city": "KAYENTA",
"state": "AZ",
"postal_code": "860330368",
"telephone_number": "928-697-4100",
"fax_number": "928-697-4029"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "JEREMY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-24",
"last_updated": "2020-07-24",
"certification_date": "2020-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "163WE0003X",
"taxonomy_group": "",
"desc": "Registered Nurse, Emergency",
"state": "AR",
"license": "R104770",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kayenta, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 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.