Provider Demographics
NPI:1649734054
Name:KING, NACKYANA CHRISTINE
Entity type:Individual
Prefix:MRS
First Name:NACKYANA
Middle Name:CHRISTINE
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:NACKYANA
Other - Middle Name:C
Other - Last Name:MORENCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5366
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32793-5366
Mailing Address - Country:US
Mailing Address - Phone:954-668-9535
Mailing Address - Fax:
Practice Address - Street 1:212 STATE ROAD 436 # 212
Practice Address - Street 2:
Practice Address - City:CASSELBERRY
Practice Address - State:FL
Practice Address - Zip Code:32707-4943
Practice Address - Country:US
Practice Address - Phone:689-255-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-30
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107458000Medicaid