Provider Demographics
NPI:1154035863
Name:KINGSTON, ASALIA GUADALUPE (FNP)
Entity type:Individual
Prefix:
First Name:ASALIA
Middle Name:GUADALUPE
Last Name:KINGSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:766 S MARTIN ST APT A329
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6137
Mailing Address - Country:US
Mailing Address - Phone:970-331-2232
Mailing Address - Fax:
Practice Address - Street 1:1130 38TH AVE STE A
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2581
Practice Address - Country:US
Practice Address - Phone:970-888-0399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0998332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily