Provider Demographics
NPI:1922511385
Name:KING, CHRISTEN MARRIELLE (PDHA I)
Entity Type:Individual
Prefix:MS
First Name:CHRISTEN
Middle Name:MARRIELLE
Last Name:KING
Suffix:
Gender:F
Credentials:PDHA I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 CHANNEL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7837
Mailing Address - Country:US
Mailing Address - Phone:907-463-6675
Mailing Address - Fax:
Practice Address - Street 1:725 RELAY ROAD
Practice Address - Street 2:
Practice Address - City:ANGOON
Practice Address - State:AK
Practice Address - Zip Code:99820
Practice Address - Country:US
Practice Address - Phone:907-788-4655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-08
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
17-144-PDHA1OtherCOMMUNITY HEALTH AIDE PROGRAM CERTIFICATION BOARD- FEDERAL CERTIFICATION