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NPI Code Detail

MEDICARE: BRIAN KING PSYD

MEDICARE: BRIAN KING PSYD
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
1103TC0700XClinical PsychologistKY-1610KY

General Provider Information

NPI Number : 1407183809
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRIAN KING PSYD
Provider Business Mailing Address
First Line : 1218 E BURNETT AVE
Second Line :
City : LOUISVILLE
State : KY
Zip : 40217-1524
Country : US
Telephone Number : 502-594-7541
Fax Number :
Provider Business Practice Location Address
First Line : 1161 E BROADWAY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40204-1711
Country : US
Telephone Number : 502-561-0952
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/06/2009
Last Update Date : 07/10/2023

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