Healthcare Provider Details

I. General information

NPI: 1184537136
Provider Name (Legal Business Name): KIMBERLY NICOLE KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2632 M L K JR AVE SE APT 117
WASHINGTON DC
20020-7736
US

IV. Provider business mailing address

23424 RAINBOW ARCH DR # 108
CLARKSBURG MD
20871-4462
US

V. Phone/Fax

Practice location:
  • Phone: 240-234-8667
  • Fax:
Mailing address:
  • Phone: 240-234-8667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: