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NPI Code Detail

MEDICARE: GAYLEANN KING

MEDICARE:   GAYLEANN  KING
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QD1600XDevelopmental Disabilities Clinic/Center

General Provider Information

NPI Number : 1063920882
Entity Type Code : Individual
Provider Name (Legal Business Name) : GAYLEANN KING
Provider Business Mailing Address
First Line : 2901 AVENUE D
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-2663
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2901 AVENUE D
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-2663
Country : US
Telephone Number : 772-626-4456
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/15/2018
Last Update Date : 01/15/2018

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Directions to “ GAYLEANN KING ” Practice Location

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