Provider Demographics
NPI:1205888682
Name:PILGRIM-KING, KAREN ALEXIS (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ALEXIS
Last Name:PILGRIM-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 1:4808 GRAPEVINE TER
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-2920
Mailing Address - Country:US
Mailing Address - Phone:817-346-2153
Mailing Address - Fax:817-292-7985
Practice Address - Street 1:1126 W PIONEER PKWY
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-6367
Practice Address - Country:US
Practice Address - Phone:817-277-1329
Practice Address - Fax:817-277-1369
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0529208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8W4320OtherBCBS PROVIDER ID
TX7604028OtherAETNA PROVIDER NUMBER
TX10060071OtherAMERIGROUP PROVIDER ID
TX170312602Medicaid
TX170312602Medicaid