MEDICARE: ASHLEY RENEE KING RN

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	202C00000X	Independent Medical Examiner Physician	201806654RN	OR

General Provider Information

NPI Number	:	1508505264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY RENEE KING RN

Provider Business Mailing Address
First Line	:	213 WATER AVE NW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-2298
Country	:	US
Telephone Number	:	541-371-2080
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 WATER AVE NW
Second Line	:
City	:	ALBANY
State	:	OR
Zip	:	97321-2298
Country	:	US
Telephone Number	:	541-371-2080
Fax Number	:

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

Provider Enumeration Date	:	06/01/2022
Last Update Date	:	06/01/2022

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