Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 2019000490 | MO |
N | 207Q00000X | Family Doctor | 2016021991 | MO |
NPI | 1255884359 |
---|---|
Provider Name | Dr. Alicia Ann King |
First Address | Sikeston, MO 63801-5044 |
Second Address | Sikeston, MO 63801-9382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2016 |
Last Update Date | 17/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200071642 | (05) | MO |