Provider Demographics
NPI:1518007384
Name:KING, PIXIE (RD, CDE)
Entity Type:Individual
Prefix:
First Name:PIXIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:RATCLIFF
Mailing Address - State:AR
Mailing Address - Zip Code:72951-0130
Mailing Address - Country:US
Mailing Address - Phone:479-635-5300
Mailing Address - Fax:479-635-2010
Practice Address - Street 1:815 FORT ST
Practice Address - Street 2:SUITE B
Practice Address - City:BARLING
Practice Address - State:AR
Practice Address - Zip Code:72923-2164
Practice Address - Country:US
Practice Address - Phone:479-434-4747
Practice Address - Fax:479-434-4949
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5W822Medicare ID - Type Unspecified
ARP56273Medicare UPIN