Provider Demographics
NPI:1316498173
Name:KINGSLEY, DENISE (LPN)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1233
Mailing Address - Country:US
Mailing Address - Phone:607-426-5167
Mailing Address - Fax:
Practice Address - Street 1:200 W 16TH ST
Practice Address - Street 2:
Practice Address - City:ELMIRA HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:14903-1233
Practice Address - Country:US
Practice Address - Phone:607-426-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY140665164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse