1689966855 NPI number — DR. KRISTEN ANNE KING PH.D.

Table of content: DR. KRISTEN ANNE KING PH.D. (NPI 1689966855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689966855 NPI number — DR. KRISTEN ANNE KING PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KING
Provider First Name:
KRISTEN
Provider Middle Name:
ANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1689966855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26170
Provider Second Line Business Mailing Address:
1100 WEST MARKET STREET, 3RD FLOOR
Provider Business Mailing Address City Name:
GREENSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27402-6170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-346-3192
Provider Business Mailing Address Fax Number:
336-346-3197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 W MARKET ST FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27403-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-346-3192
Provider Business Practice Location Address Fax Number:
336-346-3197
Provider Enumeration Date:
05/06/2011

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: 103TC0700X , with the licence number:  4108 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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