Individual
KEONNA SHADAE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS, LAT, ATC
Contact information
Practice address
4900 MERIDIAN ST NW, NORMAL, AL 35762-7500
(256) 372-8457
Mailing address
710 JULIA ST NW APT 10, HUNTSVILLE, AL 35816-3741
(334) 322-8973
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2530
AL
Other
Enumeration date
11/07/2022
Last updated
11/07/2022
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