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Individual
KORTREZ KING
Active
Individual
KORTREZ KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704319078
MI
363LF0000X
Family Nurse Practitioner
Primary
4704319078
MI
363LF0000X
Family Nurse Practitioner
4704319078NSA2304W
MI
Other
Enumeration date
03/07/2023
Last updated
03/04/2025
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