Provider Demographics
NPI:1184663478
Name:KING, CAROLINE MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:MICHELE
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 SCRIPTURE ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-4340
Mailing Address - Country:US
Mailing Address - Phone:940-591-7900
Mailing Address - Fax:
Practice Address - Street 1:2660 SCRIPTURE ST STE 110
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-4340
Practice Address - Country:US
Practice Address - Phone:940-591-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX104889409Medicaid
TX104889403Medicaid
TX104889403Medicaid
TXTXB139883Medicare PIN
TX00580QMedicare PIN
TXG28213Medicare UPIN
TXTXB139891Medicare PIN