Provider Demographics
NPI:1356908255
Name:KING, LATOYA
Entity type:Individual
Prefix:MRS
First Name:LATOYA
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 1:200B CASTLERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ELM
Mailing Address - State:TX
Mailing Address - Zip Code:75068-5527
Mailing Address - Country:US
Mailing Address - Phone:972-804-2429
Mailing Address - Fax:877-899-2601
Practice Address - Street 1:2705 LITTLE ELM PKWY STE 180
Practice Address - Street 2:
Practice Address - City:LITTLE ELM
Practice Address - State:TX
Practice Address - Zip Code:75068-6698
Practice Address - Country:US
Practice Address - Phone:972-804-2429
Practice Address - Fax:877-899-2601
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-26
Last Update Date:2019-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16856071744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1685607OtherPROSTHETIC SPECIALIST