Individual
JENA RAE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3300 W CENTRE AVE, PORTAGE, MI 49024-4666
(269) 324-8950
Mailing address
601 JOHN STREET, BOX 39, KALAMAZOO, MI 49007
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704231067
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500C810570
BCBSM
MI
Enumeration date
09/13/2007
Last updated
10/13/2022
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