Provider Demographics
NPI:1285895821
Name:KINGERY, DESIRAE DENISE (MHAI)
Entity type:Individual
Prefix:
First Name:DESIRAE
Middle Name:DENISE
Last Name:KINGERY
Suffix:
Gender:F
Credentials:MHAI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 STOCKTON BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2301
Mailing Address - Country:US
Mailing Address - Phone:916-736-6727
Mailing Address - Fax:
Practice Address - Street 1:2830 STOCKTON BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2301
Practice Address - Country:US
Practice Address - Phone:916-736-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator