Provider Demographics
NPI:1194321158
Name:KING, OKEY III
Entity type:Individual
Prefix:
First Name:OKEY
Middle Name:
Last Name:KING
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:248 RED OAKS SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:RONCEVERTE
Mailing Address - State:WV
Mailing Address - Zip Code:24970-1349
Mailing Address - Country:US
Mailing Address - Phone:304-645-6226
Mailing Address - Fax:
Practice Address - Street 1:248 RED OAKS SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:RONCEVERTE
Practice Address - State:WV
Practice Address - Zip Code:24970-1349
Practice Address - Country:US
Practice Address - Phone:304-645-6226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator