King, Theresa Shelly

King, Theresa Shelly is an individual health care provider with primary practice located at 1901 Mission 66 Suite A, Vicksburg MS 39180-3711. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / General Care, which is considered as her primary health care specialty. King, Theresa Shelly can be contacted via phone (601) 638-4076.

Contact Information

Primary practice address
1901 Mission 66 Suite A Vicksburg MS 39180-3711
Phone: (601) 638-4076
Fax: (601) 638-4979
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / General Care 2278G1100X RCP 1299 Mississippi

Profile Details

NPI number 1255484481
LBN Legal business name King, Theresa Shelly
Credentials RCP
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 19th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255484481 NPPES
Mississippi Other 7737511 AETNA #

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