Individual
MISS JACQUELINE YVONNE KING
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7212 ISHERWOOD RD, MEMPHIS, TN 38125-2119
(901) 644-8682
Mailing address
7212 ISHERWOOD RD, MEMPHIS, TN 38125-2119
(901) 644-8682
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
86654164
TN
343900000X
Non-emergency Medical Transport (VAN)
Primary
86654164
TN
347C00000X
Private Vehicle
86654164
TN
Other
Enumeration date
11/09/2012
Last updated
05/16/2013
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