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NPI Code Detail

MEDICARE: AMANDA RENEE KING DO

MEDICARE: AMANDA RENEE KING DO
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
12084P0800XPsychiatry PhysicianDO2985NV
2390200000XStudent in an Organized Health Care Education/Training Program
32084P0804XChild & Adolescent Psychiatry PhysicianDO2985NV

General Provider Information

NPI Number : 1740641661
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA RENEE KING DO
Provider Business Mailing Address
First Line : 5515 BLUE DIAMOND ROAD
Second Line : SUITE 102 PMB 1011
City : LAS VEGAS
State : NV
Zip : 89139
Country : US
Telephone Number : 317-450-3454
Fax Number : 317-647-4311
Provider Business Practice Location Address
First Line : 526 S TONOPAH DR STE 200
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4013
Country : US
Telephone Number : 702-440-8430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/20/2016
Last Update Date : 11/17/2025

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