Individual
MERRI ANN KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CDE
Contact information
Practice address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4433
(208) 934-4433
Mailing address
267 N CANYON DR, GOODING, ID 83330-5500
(208) 934-4433
(208) 735-3718
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
Primary
N-23187
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1370131
PART B MEDICARE
ID
05
—
1609046671
—
ID
Enumeration date
01/23/2018
Last updated
01/23/2018
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