Provider Demographics
NPI:1417680380
Name:KING, DAMIEANN
Entity Type:Individual
Prefix:
First Name:DAMIEANN
Middle Name:
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 1:954 SHIRLEY LN
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26710-4557
Mailing Address - Country:US
Mailing Address - Phone:240-321-3579
Mailing Address - Fax:
Practice Address - Street 1:954 SHIRLEY LN
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:WV
Practice Address - Zip Code:26710-4557
Practice Address - Country:US
Practice Address - Phone:240-321-3579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-07
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant