Provider Demographics
NPI:1417708298
Name:KING, BREONSHAY
Entity Type:Individual
Prefix:
First Name:BREONSHAY
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 1:8032 MONCRIEF DINSMORE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32219-3602
Mailing Address - Country:US
Mailing Address - Phone:214-937-1219
Mailing Address - Fax:
Practice Address - Street 1:8032 MONCRIEF DINSMORE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32219-3602
Practice Address - Country:US
Practice Address - Phone:214-937-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker