Provider Demographics
NPI:1053798645
Name:KING, CHASTITY
Entity type:Individual
Prefix:
First Name:CHASTITY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 QUIET CREEK DRIVE
Mailing Address - Street 2:APT#46
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-8862
Mailing Address - Country:US
Mailing Address - Phone:513-307-5549
Mailing Address - Fax:
Practice Address - Street 1:11 QUIET CREEK DR
Practice Address - Street 2:APT#46
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-8862
Practice Address - Country:US
Practice Address - Phone:513-307-5549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-03
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154839164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse