MEDICARE: DARNELLA 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	3747A0650X	Attendant Care Provider		VA

General Provider Information

NPI Number	:	1639742752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARNELLA KING

Provider Business Mailing Address
First Line	:	13 CEDARCROFT CT
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23805-2521
Country	:	US
Telephone Number	:	804-299-1798
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 W WASHINGTON ST
Second Line	:
City	:	PETERSBURG
State	:	VA
Zip	:	23803-4132
Country	:	US
Telephone Number	:	804-299-1798
Fax Number	:

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

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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Directions to “ DARNELLA KING ” Practice Location

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