MEDICARE: MRS. AMBER DANIELLE KING RN BSN

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
1	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	RN294858	OH
2	163W00000X	Registered Nurse	RN294858	OH

General Provider Information

NPI Number	:	1356953491
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER DANIELLE KING RN BSN

Provider Business Mailing Address
First Line	:	4352 WESTPORT RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-2042
Country	:	US
Telephone Number	:	614-971-1318
Fax Number	:

Provider Business Practice Location Address
First Line	:	4352 WESTPORT RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43228-2042
Country	:	US
Telephone Number	:	614-971-1318
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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