Provider Demographics
NPI:1700234671
Name:KING, KACI
Entity Type:Individual
Prefix:
First Name:KACI
Middle Name:
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 1:610 DRAGON DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:OR
Mailing Address - Zip Code:97456-9604
Mailing Address - Country:US
Mailing Address - Phone:541-847-5143
Mailing Address - Fax:541-847-5144
Practice Address - Street 1:610 DRAGON DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OR
Practice Address - Zip Code:97456-9604
Practice Address - Country:US
Practice Address - Phone:541-847-5143
Practice Address - Fax:541-847-5144
Is Sole Proprietor?:No
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider