Provider Demographics
NPI:1003556036
Name:KING, CLAUDETT RENEE
Entity Type:Individual
Prefix:
First Name:CLAUDETT
Middle Name:RENEE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:174 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9447
Mailing Address - Country:US
Mailing Address - Phone:185-920-9047
Mailing Address - Fax:
Practice Address - Street 1:174 SCOTT DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9447
Practice Address - Country:US
Practice Address - Phone:859-209-0474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker