Provider Demographics
NPI:1689408080
Name:KING, MOLLY (FNP-C, APRN)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 MARKETPLACE BLVD UNIT 4
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-4573
Mailing Address - Country:US
Mailing Address - Phone:603-512-6454
Mailing Address - Fax:
Practice Address - Street 1:155 MARKETPLACE BLVD UNIT 4
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-4573
Practice Address - Country:US
Practice Address - Phone:603-512-6454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH080435-23363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner