Provider Demographics
NPI:1952150906
Name:KING, DEVERA
Entity type:Individual
Prefix:
First Name:DEVERA
Middle Name:
Last Name:KING
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 1:10111 STEEPLECHASE DR APT 111E
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-1106
Mailing Address - Country:US
Mailing Address - Phone:463-269-9153
Mailing Address - Fax:
Practice Address - Street 1:10111 STEEPLECHASE DR APT 111E
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-1106
Practice Address - Country:US
Practice Address - Phone:463-269-9153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN23-015329-13747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant