Provider Information for 1053048595
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JOY KING
Sex: Female
NPI: 1053048595
Last Updated: 2022-08-04
Certification Date: 2022-07-27
Certification Date: 2022-07-27
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1053048595 | ||||||||
| Enumeration Date | 2022-08-04 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | PO BOX 668 LYNDONVILLE, VT 05851-0668 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 961 CENTER STREET LYNDONVILLE, VT 05851 United States Phone: 802-535-4071 | Fax: | ||||||||
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