Provider Demographics
NPI:1609090869
Name:KING, RACHEL CH (MD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:CH
Last Name:KING
Suffix:
Gender:F
Credentials:MD
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 397
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-0397
Mailing Address - Country:US
Mailing Address - Phone:870-898-5464
Mailing Address - Fax:870-898-4606
Practice Address - Street 1:180 HWY. 71 SOUTH
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-8650
Practice Address - Country:US
Practice Address - Phone:870-898-5464
Practice Address - Fax:870-898-4606
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-6014208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR176919001Medicaid
AR5H496Medicare PIN