Provider Demographics
NPI:1417154113
Name:KING, TAAS NAKA WORLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:TAAS
Middle Name:NAKA WORLEY
Last Name:KING
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TAAS
Other - Middle Name:NAKA
Other - Last Name:WORLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1115 SE 164TH AVE
Mailing Address - Street 2:DEPT 358
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-9324
Mailing Address - Country:US
Mailing Address - Phone:360-788-6870
Mailing Address - Fax:360-788-6872
Practice Address - Street 1:710 BIRCHWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1720
Practice Address - Country:US
Practice Address - Phone:360-788-6870
Practice Address - Fax:360-788-6872
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010173752084N0400X
WAOP604631522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1417154113Medicaid