Provider Demographics
NPI:1598038655
Name:KING, JAMES BRIAN
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:BRIAN
Last Name:KING
Suffix:
Gender:M
Credentials:
Other - Prefix:MS
Other - First Name:AMIE
Other - Middle Name:RUSK
Other - Last Name:FERGUSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:410 MAGAZINE CT
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-6262
Mailing Address - Country:US
Mailing Address - Phone:318-505-2137
Mailing Address - Fax:318-918-7653
Practice Address - Street 1:410 MAGAZINE CT
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-6262
Practice Address - Country:US
Practice Address - Phone:318-505-2137
Practice Address - Fax:318-918-7653
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-20
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA004672282343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)