King, Darrell L

King, Darrell L is an individual health care provider with primary practice located at 500 W. Fort Street Boise Va, Boise ID 83702-4501. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. King, Darrell L can be contacted via phone (208) 422-1136.

Contact Information

Primary practice address
500 W. Fort Street Boise Va Boise ID 83702-4501
Phone: (208) 422-1136
Fax: (208) 422-1083
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA235 Idaho

Profile Details

NPI number 1770573644
LBN Legal business name King, Darrell L
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 24th, 2005
Last updated Feb 6th, 2012 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770573644 NPPES
Idaho Other 970029609 RR MEDICARE
Idaho Other 000010141117 RR MEDICARE
Idaho Other PADA5 RR MEDICARE
Idaho Other 000010141122 RR MEDICARE
Idaho Other PADB3 RR MEDICARE
Idaho MEDICAID 805341400 RR MEDICARE

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