MEDICARE: KATRINA NICOLE 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
1	374U00000X	Home Health Aide		OH

General Provider Information

NPI Number	:	1457288821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA NICOLE KING

Provider Business Mailing Address
First Line	:	541 E 118TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1841
Country	:	US
Telephone Number	:	216-659-5041
Fax Number	:

Provider Business Practice Location Address
First Line	:	541 E 118TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44108-1841
Country	:	US
Telephone Number	:	216-659-5041
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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Directions to “ KATRINA NICOLE KING ” Practice Location

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