Healthcare Provider Details

I. General information

NPI: 1922734136
Provider Name (Legal Business Name): KING HEALTH & WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

585 MURPHY RD
MEDFORD OR
97504
US

IV. Provider business mailing address

585 MURPHY RD
MEDFORD OR
97504
US

V. Phone/Fax

Practice location:
  • Phone: 541-292-6464
  • Fax: 458-225-9821
Mailing address:
  • Phone: 541-292-6464
  • Fax: 458-225-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JULIE ANN KING
Title or Position: OWNER/PROVIDER
Credential: MD, FACOG
Phone: 541-500-4747