Provider Demographics
NPI:1336535806
Name:KING, KLONDA
Entity Type:Individual
Prefix:
First Name:KLONDA
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 1:6156 LAKE PADDOCK DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-4721
Mailing Address - Country:US
Mailing Address - Phone:314-604-2285
Mailing Address - Fax:
Practice Address - Street 1:3321 UNION BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63115-1119
Practice Address - Country:US
Practice Address - Phone:636-220-1395
Practice Address - Fax:636-220-1396
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-12
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide