Provider Demographics
NPI:1659904324
Name:KING, ODDNEY L
Entity Type:Individual
Prefix:
First Name:ODDNEY
Middle Name:L
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 1:710 TIDAL ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:BURKBURNETT
Mailing Address - State:TX
Mailing Address - Zip Code:76354-2757
Mailing Address - Country:US
Mailing Address - Phone:940-232-6095
Mailing Address - Fax:
Practice Address - Street 1:1403 FAIRLEY AVE APT B
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-3320
Practice Address - Country:US
Practice Address - Phone:940-232-6094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care