Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 40564 | CO |
Y | 2080P0204X | Pediatric Emergency Doctor | M-12230 | ID |
NPI | 1235214586 |
---|---|
Provider Name | Jennifer King |
First Address | Meridian, ID 83642-1026 |
Second Address | Boise, ID 83704 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2006 |
Last Update Date | 10/11/2016 |