Provider Demographics
NPI:1649833369
Name:KING, TRAVIS MICHAEL (RDN)
Entity type:Individual
Prefix:
First Name:TRAVIS
Middle Name:MICHAEL
Last Name:KING
Suffix:
Gender:M
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 N LANDING WAY # 1051
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5521
Mailing Address - Country:US
Mailing Address - Phone:206-657-7133
Mailing Address - Fax:
Practice Address - Street 1:1207 N LANDING WAY # 1051
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5521
Practice Address - Country:US
Practice Address - Phone:206-657-7133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI60626588133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered