Provider Demographics
NPI:1164789954
Name:KING, RASHONDA NICOLE
Entity Type:Individual
Prefix:
First Name:RASHONDA
Middle Name:NICOLE
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 1:7155 E JASPER ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-7853
Mailing Address - Country:US
Mailing Address - Phone:918-814-5628
Mailing Address - Fax:539-664-4622
Practice Address - Street 1:130 N GREENWOOD AVE STE 200-210
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74120-1409
Practice Address - Country:US
Practice Address - Phone:918-664-4621
Practice Address - Fax:918-664-4622
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator