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NPI Code Detail

MEDICARE: JENNIFER RAE KING M.D.

MEDICARE: JENNIFER RAE KING M.D.
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
12084P0804XChild & Adolescent Psychiatry Physician36971-020WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770647364
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER RAE KING M.D.
Provider Business Mailing Address
First Line : 8200 W SILVER SPRING DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53218-2552
Country : US
Telephone Number : 414-267-8521
Fax Number : 414-464-6472
Provider Business Practice Location Address
First Line : 8200 W SILVER SPRING DR
Second Line :
City : MILWAUKEE
State : WI
Zip : 53218-2552
Country : US
Telephone Number : 414-267-8521
Fax Number : 414-464-6472
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 12/01/2021

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