Brenda Doreen King, 01/01/2011

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

252Y00000X Issued in KY

Practice address

301 Elmhurst Ave
Vine Grove, KY 40175-1211

Phone

(270) 317-0669

NPI assigned

Sep 7, 2012

Sex

Female

Sole proprietor

Yes

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 7, 2012.

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346976000000",
    "number": "1659620425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 ELMHURST AVE",
            "city": "VINE GROVE",
            "state": "KY",
            "postal_code": "401751211",
            "telephone_number": "270-317-0669"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 ELMHURST AVE",
            "city": "VINE GROVE",
            "state": "KY",
            "postal_code": "401751211",
            "telephone_number": "270-317-0669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KING",
        "first_name": "BRENDA",
        "middle_name": "DOREEN",
        "credential": "01/01/2011",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-07",
        "last_updated": "2012-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "KY",
            "license": "252Y00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Vine Grove, KY
• Early Intervention Provider Agency in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.