Provider Information for 1376026880
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KELLI KING LPC
Sex: Female
NPI: 1376026880
Last Updated: 2023-02-16
Certification Date: 2023-02-16
Certification Date: 2023-02-16
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1376026880 | ||||||||
| Enumeration Date | 2018-09-11 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2105 HOLLOW WOOD WAY HAUGHTON, LA 71037-7723 United States Phone: 318-464-4594 | Fax: | ||||||||
| Primary Practice Address | 2105 HOLLOW WOOD WAY HAUGHTON, LA 71037-7723 United States Phone: 184-644-5943 | Fax: | ||||||||
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