Healthcare Provider Details

I. General information

NPI: 1356908255
Provider Name (Legal Business Name): MRS. LATOYA KING
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2019
Last Update Date: 05/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 LITTLE ELM PKWY STE 180
LITTLE ELM TX
75068-6698
US

IV. Provider business mailing address

200B CASTLERIDGE DR
LITTLE ELM TX
75068-5527
US

V. Phone/Fax

Practice location:
  • Phone: 972-804-2429
  • Fax: 877-899-2601
Mailing address:
  • Phone: 972-804-2429
  • Fax: 877-899-2601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number1685607
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: