Individual
DR. JESSICA RENEE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1905 W 19TH ST, MOUNTAIN GROVE, MO 65711-1287
(417) 926-1770
(417) 926-1785
Mailing address
1905 W 19TH ST, MOUNTAIN GROVE, MO 65711-1287
(417) 926-1770
(417) 926-1785
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2008017836
MO
207Q00000X
Family Medicine Physician
Primary
2009020461
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1649434200
—
MO
05
—
204253207
—
MO
01
—
26D0889777
CLIA
MO
01
—
26D2006074
CLIA
MO
05
—
504114802
—
MO
05
—
507780302
—
MO
05
—
594438806
—
MO
05
—
597780303
—
MO
01
—
P01296849
RAILROAD MEDICARE
MO
Enumeration date
07/14/2008
Last updated
04/29/2020
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