Provider Demographics
NPI:1740579150
Name:KING, KRISTI RENEA (MD)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:RENEA
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BONNIE BRAE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76111-4358
Mailing Address - Country:US
Mailing Address - Phone:817-838-5433
Mailing Address - Fax:855-552-6041
Practice Address - Street 1:1000 BONNIE BRAE AVE STE 120
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76111-4358
Practice Address - Country:US
Practice Address - Phone:817-838-5433
Practice Address - Fax:855-552-6041
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0079627207V00000X
TXS3693207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology