MEDICARE: JENELLE DONITA KING MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1972779114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENELLE DONITA KING MD

Provider Business Mailing Address
First Line	:	6 JUBILEE COURT
Second Line	:
City	:	CLARENVILLE
State	:	NL
Zip	:	A5A159
Country	:	CA
Telephone Number	:	709-466-1919
Fax Number	:

Provider Business Practice Location Address
First Line	:	2411 HOLMES STREET
Second Line	:	UMKC SCHOOL OF MEDICINE RESIDENCY PROGRAM M2-302
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-2792
Country	:	US
Telephone Number	:	816-404-5345
Fax Number	:	816-404-5381

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

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/07/2008

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