Provider Demographics
NPI:1780724369
Name:CONNIE Y TORRENCE KING
Entity type:Organization
Organization Name:CONNIE Y TORRENCE KING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:YVETTE
Authorized Official - Last Name:TORRENCE-KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-673-6209
Mailing Address - Street 1:15114 WOODSTONE DR
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-8303
Mailing Address - Country:US
Mailing Address - Phone:225-673-6209
Mailing Address - Fax:225-642-1946
Practice Address - Street 1:15114 WOODSTONE DR
Practice Address - Street 2:
Practice Address - City:PRAIRIEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70769-8303
Practice Address - Country:US
Practice Address - Phone:225-673-6209
Practice Address - Fax:225-642-1946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA553715133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty