Provider Demographics
NPI:1265930598
Name:KING, SHARON
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:968 SIERRA ST # 244
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-1554
Mailing Address - Country:US
Mailing Address - Phone:559-897-7074
Mailing Address - Fax:559-896-1994
Practice Address - Street 1:6296 E. MT. VIEW AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662
Practice Address - Country:US
Practice Address - Phone:559-897-7074
Practice Address - Fax:559-896-1994
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104700028374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide