Provider Demographics
NPI:1902651235
Name:KING, ASHLEIGH NICHOLE (PARAMEDICAL TATTOO)
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:NICHOLE
Last Name:KING
Suffix:
Gender:F
Credentials:PARAMEDICAL TATTOO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1244 PARK HILL ST
Mailing Address - Street 2:
Mailing Address - City:RATON
Mailing Address - State:NM
Mailing Address - Zip Code:87740-4424
Mailing Address - Country:US
Mailing Address - Phone:505-617-5912
Mailing Address - Fax:
Practice Address - Street 1:127 N COMMERCIAL ST # 216
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2608
Practice Address - Country:US
Practice Address - Phone:505-617-5912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty