Provider Demographics
NPI:1912408923
Name:KING, DALLAS R (LVN)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:R
Last Name:KING
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7510 DECKER DR APT 1308
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-1069
Mailing Address - Country:US
Mailing Address - Phone:281-515-5824
Mailing Address - Fax:281-838-8009
Practice Address - Street 1:18011 SECO CREEK LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77396-4681
Practice Address - Country:US
Practice Address - Phone:281-515-5824
Practice Address - Fax:281-838-8009
Is Sole Proprietor?:No
Enumeration Date:2018-02-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX224864164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse