Provider Demographics
NPI:1649508185
Name:KING-MARCUS, CAROLYN JO
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JO
Last Name:KING-MARCUS
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 1:947 RD 47
Mailing Address - Street 2:
Mailing Address - City:TEN SLEEP
Mailing Address - State:WY
Mailing Address - Zip Code:82442
Mailing Address - Country:US
Mailing Address - Phone:307-366-2577
Mailing Address - Fax:
Practice Address - Street 1:947 RD. 47
Practice Address - Street 2:
Practice Address - City:TEN SLEEP
Practice Address - State:WY
Practice Address - Zip Code:82442
Practice Address - Country:US
Practice Address - Phone:307-366-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator