Healthcare Provider Details

I. General information

NPI: 1164031852
Provider Name (Legal Business Name): AMY KING
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 WHEELWRIGHT DR
MANCHESTER MO
63021-6659
US

IV. Provider business mailing address

836 WHEELWRIGHT DR
MANCHESTER MO
63021-6659
US

V. Phone/Fax

Practice location:
  • Phone: 618-964-7324
  • Fax:
Mailing address:
  • Phone: 618-964-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2026031051
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: