Provider Demographics
NPI:1134564230
Name:KING, KATANA BETH (ND)
Entity type:Individual
Prefix:DR
First Name:KATANA
Middle Name:BETH
Last Name:KING
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-2901
Mailing Address - Country:US
Mailing Address - Phone:360-200-1080
Mailing Address - Fax:360-200-1081
Practice Address - Street 1:1424 16TH AVE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-2901
Practice Address - Country:US
Practice Address - Phone:360-200-1080
Practice Address - Fax:360-200-1081
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-02
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60357746175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath