Provider Demographics
NPI:1275695280
Name:KING, KEVIN BERNARD (KEVIN KING)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:BERNARD
Last Name:KING
Suffix:
Gender:M
Credentials:KEVIN KING
Other - Prefix:MR
Other - First Name:KEVIN
Other - Middle Name:BERNARD
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:KEVIN KING,ATC,CSCS
Mailing Address - Street 1:800 S MINT ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28202-1518
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 S MINT ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28202-1518
Practice Address - Country:US
Practice Address - Phone:860-416-2529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC09642255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer