Provider Demographics
NPI:1144063157
Name:AQKINGMSRDNLLC
Entity type:Organization
Organization Name:AQKINGMSRDNLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:METABOLIC DIETITIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:Q
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, CDCES
Authorized Official - Phone:804-720-1132
Mailing Address - Street 1:2685 DORSET RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:POWHATAN
Mailing Address - State:VA
Mailing Address - Zip Code:23139-7541
Mailing Address - Country:US
Mailing Address - Phone:804-720-1132
Mailing Address - Fax:
Practice Address - Street 1:2685 DORSET RIDGE TER
Practice Address - Street 2:
Practice Address - City:POWHATAN
Practice Address - State:VA
Practice Address - Zip Code:23139-7541
Practice Address - Country:US
Practice Address - Phone:804-720-1132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, MetabolicGroup - Single Specialty