Provider Demographics
NPI:1063992238
Name:KINGSBY, ALESHA N
Entity type:Individual
Prefix:MS
First Name:ALESHA
Middle Name:N
Last Name:KINGSBY
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 1:653 W 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-2949
Mailing Address - Country:US
Mailing Address - Phone:318-636-8389
Mailing Address - Fax:318-319-2151
Practice Address - Street 1:653 W 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-2949
Practice Address - Country:US
Practice Address - Phone:318-636-8389
Practice Address - Fax:318-319-2151
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP200083363LP2300X
LAF06181386363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care