Basic Information
| Provider Information | |||||||||
| NPI: | 1518007384 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | PIXIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | RD, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 130 | ||||||||
| Address2: | |||||||||
| City: | RATCLIFF | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729510130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4796355300 | ||||||||
| FaxNumber: | 4796352010 | ||||||||
| Practice Location | |||||||||
| Address1: | 815 FORT ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | BARLING | ||||||||
| State: | AR | ||||||||
| PostalCode: | 729232164 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4794344747 | ||||||||
| FaxNumber: | 4794344949 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2007 | ||||||||
| LastUpdateDate: | 07/14/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 0147 | AR | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.