Individual
DANIELLE L KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1017 12TH AVE, FORT WORTH, TX 76104-3915
(817) 334-2800
(817) 820-0094
Mailing address
1017 12TH AVE, FORT WORTH, TX 76104-3915
(817) 334-2800
(817) 820-0094
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA09434
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
343725302
—
TX
Enumeration date
10/22/2014
Last updated
10/12/2021
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