MEDICARE: ANNE KING CLD, CHW

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	172V00000X	Community Health Worker		NV
2	374J00000X	Doula	14445501AK	NC

General Provider Information

NPI Number	:	1619508140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNE KING CLD, CHW

Provider Business Mailing Address
First Line	:	1828 PLUM CT
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89014-4026
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6290 S PECOS RD STE 400
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89120-3225
Country	:	US
Telephone Number	:	702-481-3175
Fax Number	:

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

Provider Enumeration Date	:	02/03/2020
Last Update Date	:	02/03/2020

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