MEDICARE: ANITRA S 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	3747P1801X	Personal Care Attendant	24-017479-1	IN
2	106S00000X	Behavior Technician		IN

General Provider Information

NPI Number	:	1962078162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITRA S KING

Provider Business Mailing Address
First Line	:	3230 CORK BEND DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-7668
Country	:	US
Telephone Number	:	317-540-3457
Fax Number	:

Provider Business Practice Location Address
First Line	:	3230 CORK BEND DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46239-7668
Country	:	US
Telephone Number	:	317-540-3457
Fax Number	:

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

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	08/25/2024

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Directions to “ ANITRA S KING ” Practice Location

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