Provider Demographics
NPI:1003328659
Name:KING, CYNTHIA C (MS, RDN, LD, CHES)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:C
Last Name:KING
Suffix:
Gender:F
Credentials:MS, RDN, LD, CHES
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:M
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, RDN, LD, CHES
Mailing Address - Street 1:2831 LOCKERIDGE BEND DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-7031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2831 LOCKERIDGE BEND DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-7031
Practice Address - Country:US
Practice Address - Phone:936-661-6063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT84665133V00000X
86066159133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered