Provider Demographics
NPI:1710259239
Name:KING, JENNIFER LYN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
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 1:1101 WALTERS DR
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2349
Mailing Address - Country:US
Mailing Address - Phone:817-243-6582
Mailing Address - Fax:
Practice Address - Street 1:1101 WALTERS DR
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-2349
Practice Address - Country:US
Practice Address - Phone:817-243-6582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula