Provider Demographics
NPI:1356001366
Name:KING, CHEYANNE (FNTP)
Entity Type:Individual
Prefix:
First Name:CHEYANNE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:FNTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 W 43RD ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4214
Mailing Address - Country:US
Mailing Address - Phone:936-697-4523
Mailing Address - Fax:
Practice Address - Street 1:504 W 43RD ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-4214
Practice Address - Country:US
Practice Address - Phone:936-697-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5325133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist