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NPI Code Detail

MEDICARE: MS. KENYATTA D KING RN

MEDICARE: MS. KENYATTA D KING RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseRN.500300OH

General Provider Information

NPI Number : 1164679320
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KENYATTA D KING RN
Provider Business Mailing Address
First Line : 2005 ASHLAND AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43620-1703
Country : US
Telephone Number : 419-841-7701
Fax Number : 419-841-1691
Provider Business Practice Location Address
First Line : 905 NEBRASKA AVE
Second Line :
City : TOLEDO
State : OH
Zip : 43607-4222
Country : US
Telephone Number : 419-841-7701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2008
Last Update Date : 04/04/2022

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