Provider Demographics
NPI:1245005636
Name:KING, KEYONA M
Entity type:Individual
Prefix:MS
First Name:KEYONA
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11803 BROWNING AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1113
Mailing Address - Country:US
Mailing Address - Phone:216-553-2816
Mailing Address - Fax:
Practice Address - Street 1:11803 BROWNING AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1113
Practice Address - Country:US
Practice Address - Phone:216-553-2816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-16
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide