Kingdom Health Laboratory LLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

KINGDOM HEALTH LABORATORY LLC

Practice address

4887 Alpha Rd Ste 205
Dallas, TX 75244-4632

Phone

(469) 995-7851

Fax

(469) 995-7851

NPI assigned

Jan 20, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Keith J Gray

Title

Authorized Offical

Phone

(469) 995-7795

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1611100800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1611100800000",
    "number": "1689264053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4887 ALPHA RD STE 205",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752444632",
            "telephone_number": "469-995-7851",
            "fax_number": "469-995-7851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4887 ALPHA RD STE 205",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752444632",
            "telephone_number": "469-995-7851",
            "fax_number": "469-995-7851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINGDOM HEALTH LABORATORY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-20",
        "last_updated": "2021-01-20",
        "certification_date": "2021-01-20",
        "status": "A",
        "authorized_official_last_name": "GRAY",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "AUTHORIZED OFFICAL",
        "authorized_official_telephone_number": "469-995-7795"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas Alexander King, MD
• Timothy J King, RN
• Trinity King
• Tyson Terrell King
• Tia Kingcannon
• Kingdom Recovery and Injury
• Kingdom Wellness LLC
• Kingdoms Road, LLC
• Ashley McCoy Kingman, MS, CCC-SLP
• Anne Nyamagu Kingori, N.P.

• Clinical Medical Laboratory in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2021; 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.