Healthcare Provider Details

I. General information

NPI: 1003746827
Provider Name (Legal Business Name): MISS ALEXUS CHEYENNE KING-FERRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 DORRINGTON LN
MANTECA CA
95337-2061
US

IV. Provider business mailing address

1490 DORRINGTON LN
MANTECA CA
95337-2061
US

V. Phone/Fax

Practice location:
  • Phone: 510-988-3628
  • Fax:
Mailing address:
  • Phone: 510-988-3628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: