Provider Demographics
NPI:1083291322
Name:KINGSLEY, LISA (DO)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7233 CHURCH RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80021-4094
Mailing Address - Country:US
Mailing Address - Phone:303-925-4940
Mailing Address - Fax:303-925-4941
Practice Address - Street 1:7233 CHURCH RANCH BLVD
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80021-4094
Practice Address - Country:US
Practice Address - Phone:303-925-4940
Practice Address - Fax:303-925-4941
Is Sole Proprietor?:No
Enumeration Date:2021-03-24
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CODR.69542207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program