Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | APRN.CNP.022886 | OH |
NPI | 1033625637 |
---|---|
Provider Name | Craig Dennis King |
First Address | Canton, OH 44718-2384 |
Second Address | Canton, OH 44718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2017 |
Last Update Date | 18/06/2018 |