MEDICARE: BRIAN D KING MSW

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	104100000X	Social Worker	4341	KS

General Provider Information

NPI Number	:	1831389055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN D KING MSW

Provider Business Mailing Address
First Line	:	PO BOX 1060
Second Line	:
City	:	DERBY
State	:	KS
Zip	:	67037-1060
Country	:	US
Telephone Number	:	316-833-3823
Fax Number	:	316-869-2078

Provider Business Practice Location Address
First Line	:	800 E 1ST ST N
Second Line	:	STE 210
City	:	WICHITA
State	:	KS
Zip	:	67202-2740
Country	:	US
Telephone Number	:	620-326-7448
Fax Number	:

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

Provider Enumeration Date	:	07/25/2007
Last Update Date	:	09/23/2019

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