Provider Demographics
NPI:1861592057
Name:KING, JANIE DICKERT (CRNP)
Entity type:Individual
Prefix:MRS
First Name:JANIE
Middle Name:DICKERT
Last Name:KING
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MRS
Other - First Name:JANIE
Other - Middle Name:DIXON
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:324 MACON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EUFAULA
Mailing Address - State:AL
Mailing Address - Zip Code:36027-1810
Mailing Address - Country:US
Mailing Address - Phone:334-687-2494
Mailing Address - Fax:334-687-5584
Practice Address - Street 1:324 MACON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:EUFAULA
Practice Address - State:AL
Practice Address - Zip Code:36027-1810
Practice Address - Country:US
Practice Address - Phone:334-687-2494
Practice Address - Fax:334-687-5584
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-044439207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-21355OtherBLUE CROSS BLUE SHIELD AL
AL515-21355OtherBLUE CROSS BLUE SHIELD AL
ALQ13498Medicare UPIN