Provider Demographics
NPI:1700232717
Name:KING, DEBRA (RD, LD)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8045 KEY LARGO
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-5770
Mailing Address - Country:US
Mailing Address - Phone:254-939-5314
Mailing Address - Fax:
Practice Address - Street 1:8045 KEY LARGO
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-5770
Practice Address - Country:US
Practice Address - Phone:254-939-5314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-09
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT00823133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered