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General NPI Number Information
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NPI Number | 1770027971
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Entity Type | Individual
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Provider Name | MCKENNA KING
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Gender | Female
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Dates
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Enumeration Date | 12/07/2016
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 18001 N 79TH AVE STE A12
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City | GLENDALE
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State | AZ
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Zip | 85308-8398
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Country | US
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Telephone | 623-399-6825
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Fax |
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Provider Business Mailing Address
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Address Line | 3960 WALNUT DR
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City | EUREKA
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State | CA
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Zip | 95503-8938
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Country | US
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Telephone | 707-268-8722
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 86359292
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License Number State | AZ
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