Healthcare Provider Details

I. General information

NPI: 1770295008
Provider Name (Legal Business Name): KESSA KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 WESTGATE DR STE 206
BETHLEHEM PA
18017-7475
US

IV. Provider business mailing address

1225 BROAD ST APT 8
WHITEHALL PA
18052-4954
US

V. Phone/Fax

Practice location:
  • Phone: 610-596-4222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC001910
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: