Provider Demographics
NPI:1124889894
Name:KING, ANNIE (LPAT)
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34091
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87594-4091
Mailing Address - Country:US
Mailing Address - Phone:505-385-2043
Mailing Address - Fax:505-395-2915
Practice Address - Street 1:501 FRANKLIN AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-3617
Practice Address - Country:US
Practice Address - Phone:505-385-2043
Practice Address - Fax:505-395-2915
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCAT0145921221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist