Provider Demographics
NPI:1750671848
Name:KING, STACI D (MD)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:D
Last Name:KING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:17350 ST LUKES WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77384-4100
Mailing Address - Country:US
Mailing Address - Phone:832-822-5046
Mailing Address - Fax:931-321-0087
Practice Address - Street 1:17350 ST LUKES WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77384-4100
Practice Address - Country:US
Practice Address - Phone:832-822-5046
Practice Address - Fax:931-321-0087
Is Sole Proprietor?:No
Enumeration Date:2011-04-11
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
TXQ82722084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program