Provider Demographics
NPI:1912190190
Name:KING, DE SHONTA LAWANA MYERS HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:DE SHONTA
Middle Name:LAWANA MYERS HENRY
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 1:103 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28501-1603
Mailing Address - Country:US
Mailing Address - Phone:252-412-9095
Mailing Address - Fax:
Practice Address - Street 1:103 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28501-1603
Practice Address - Country:US
Practice Address - Phone:252-412-9095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-0093207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909685Medicaid
NC5909685Medicaid