King University

Primary specialty

Sports Medicine (Family Medicine) PhysicianTaxonomy code 207QS0010X

Legal business name

KING UNIVERSITY

Doing business as

King University Athletics

Practice address

1350 King College Rd
Bristol, TN 37620-2632

Phone

(972) 367-4845

NPI assigned

Nov 10, 2021

Last updated

Dec 17, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Mouzon Bass

Title

Administrator/Agent

Phone

(972) 367-4845

Specialties & licenses 1

Addresses

Other names 1

• King University Athletics Doing business as

Locations

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

{
    "created_epoch": "1636502400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639699200000",
    "number": "1780340125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15305 DALLAS PKWY STE 800",
            "city": "ADDISON",
            "state": "TX",
            "postal_code": "750016415",
            "telephone_number": "972-367-4845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1350 KING COLLEGE RD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376202632",
            "telephone_number": "972-367-4845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KING UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-10",
        "last_updated": "2021-12-17",
        "certification_date": "2021-12-17",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "MOUZON",
        "authorized_official_title_or_position": "ADMINISTRATOR/AGENT",
        "authorized_official_telephone_number": "972-367-4845",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QS0010X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "King University Athletics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "King University Athletics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Laurenrose Faith Kessler, OTD, OTR/L
• Alicia Nicole Kestner, FNP-C
• Bradley W Ketron, CRNA
• John C. Kilbreath, P.T.
• Brian Keith Killen, PA-C
• Brandy Shanks King, CRNA
• Jessica Erin King, PSY.D.
• Mary K King, CRNA
• Shelby Alexandra King, MS
• Betty Christian Kinser, RN, APRN

• Sports Medicine (Family Medicine) Physician in Bristol, TN
• Providers in Bristol, TN by specialty
• Sports Medicine (Family Medicine) Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 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.