Provider Demographics
NPI:1003674268
Name:KING, REQUEL R
Entity Type:Individual
Prefix:
First Name:REQUEL
Middle Name:R
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 1:300 W SPRING ST UNIT 301
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-7648
Mailing Address - Country:US
Mailing Address - Phone:614-670-3578
Mailing Address - Fax:
Practice Address - Street 1:300 W SPRING ST UNIT 301
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-7648
Practice Address - Country:US
Practice Address - Phone:614-670-3578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175L00000X, 251E00000X, 253Z00000X, 372600000X, 376J00000X
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No175L00000XOther Service ProvidersHomeopath
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker