King, Dustin Larue

King, Dustin Larue is an sole proprietor health care provider with primary practice located at 2500 N State St , Jackson MS 39216-4500. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Acute Care, which is considered as his primary health care specialty. King, Dustin Larue can be contacted via phone (601) 815-8151.

Contact Information

Primary practice address
2500 N State St Jackson MS 39216-4500
Phone: (601) 815-8151
Fax: (601) 815-8152
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Acute Care 363LA2100X R875042 Mississippi

Profile Details

NPI number 1669779021
LBN Legal business name King, Dustin Larue
Credentials CPNP-AC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 22nd, 2011
Last updated Jun 15th, 2012 - about 13 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 1669779021 NPPES
Mississippi Other 302I500886 MEDICARE PTAN

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