Individual
JOHN KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
10110 SPAIN RD NE, ALBUQUERQUE, NM 87111-1965
(505) 404-9395
(505) 299-4740
Mailing address
10110 SPAIN RD NE, ALBUQUERQUE, NM 87111-1965
(505) 404-9395
(505) 299-4740
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
0969
NM
103G00000X
Clinical Neuropsychologist
71006364
IL
103TP0016X
Prescribing (Medical) Psychologist
Primary
PSY-RXC0074
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
71006364
—
IL
Enumeration date
01/19/2006
Last updated
05/27/2021
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