Individual ProviderGreggy Oliver KingNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address701 Shadow Ln Ste 300, Las Vegas, NV 89106-4133(702) 383-1919(702) 383-2620PECOS EnrollmentBased on the most recent information from CMS, provider Greggy Oliver King is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1417794280Provider TypeIndividualFull NameKing, Greggy OliverGenderMaleSole ProprietorYesEnumeration Date7/10/2024Last Updated10/15/2025Contact InformationPractice LocationPractice Address701 Shadow Ln Ste 300, Las Vegas, NV 89106-4133Phone(702) 383-1919Fax(702) 383-2283Mailing LocationMailing Address1800 W Charleston Blvd, Las Vegas, NV 89102-2386Phone(702) 383-2620FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense880158Nevada