Healthcare Provider Details

I. General information

NPI: 1194314419
Provider Name (Legal Business Name): TAMIKA KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 01/12/2021
Certification Date: 01/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1072 MORADO DR
CINCINNATI OH
45238-4444
US

IV. Provider business mailing address

1072 MORADO DR
CINCINNATI OH
45238-4444
US

V. Phone/Fax

Practice location:
  • Phone: 513-535-5369
  • Fax:
Mailing address:
  • Phone: 513-535-5369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: