Provider Demographics
NPI:1710151964
Name:KING, JOAN KENERSON (RN, MSN, CS)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:KENERSON
Last Name:KING
Suffix:
Gender:F
Credentials:RN, MSN, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 KLINGERMAN RD
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1434
Mailing Address - Country:US
Mailing Address - Phone:215-721-7409
Mailing Address - Fax:215-721-2312
Practice Address - Street 1:126 KLINGERMAN RD
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1434
Practice Address - Country:US
Practice Address - Phone:215-721-7409
Practice Address - Fax:215-721-2312
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN233528L163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult