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NPI Code Detail

MEDICARE: MRS. JENNIFER R KING MA CCC A

MEDICARE: MRS. JENNIFER R KING MA CCC A
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
1237600000XAudiologist-Hearing Aid Fitter1990KS
2237600000XAudiologist-Hearing Aid Fitter2003019566MO

General Provider Information

NPI Number : 1609031038
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER R KING MA CCC A
Provider Business Mailing Address
First Line : 6 VICTORY DR
Second Line :
City : LIBERTY
State : MO
Zip : 64068-3807
Country : US
Telephone Number : 816-313-2800
Fax Number : 816-792-9819
Provider Business Practice Location Address
First Line : 101 NW ENGLEWOOD RD
Second Line :
City : GLADSTONE
State : MO
Zip : 64118-4063
Country : US
Telephone Number : 816-313-2800
Fax Number : 816-792-9819
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2008
Last Update Date : 09/11/2013

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