Provider Demographics
NPI:1588805261
Name:KING, ALICIA (MIDWIFE)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:MIDWIFE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 DRY VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-6303
Mailing Address - Country:US
Mailing Address - Phone:540-382-3031
Mailing Address - Fax:
Practice Address - Street 1:4725 DRY VALLEY RD
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-6303
Practice Address - Country:US
Practice Address - Phone:540-382-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-10
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0129000042163WM0102X, 176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn