1831425255 NPI number — MRS. CHRISTYN RENEE KING CPM, LM

Table of content: MRS. CHRISTYN RENEE KING CPM, LM (NPI 1831425255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831425255 NPI number — MRS. CHRISTYN RENEE KING CPM, LM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
CHRISTYN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPM, LM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831425255
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1235 NE 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97701-4440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-610-2450
Provider Business Mailing Address Fax Number:
541-389-5345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
464 NE NORTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97701-4387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-318-6961
Provider Business Practice Location Address Fax Number:
541-389-5345
Provider Enumeration Date:
10/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 176B00000X , with the licence number:  DEM-LV-10132774 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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