Provider Demographics
NPI:1316944242
Name:KINGREY, VICTORIA (NP)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:KINGREY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S GASSAWAY RD
Mailing Address - Street 2:
Mailing Address - City:GLASGOW
Mailing Address - State:KY
Mailing Address - Zip Code:42141-9758
Mailing Address - Country:US
Mailing Address - Phone:270-678-6793
Mailing Address - Fax:270-864-3777
Practice Address - Street 1:299A GLASGOW RD
Practice Address - Street 2:
Practice Address - City:BURKESVILLE
Practice Address - State:KY
Practice Address - Zip Code:42717-9696
Practice Address - Country:US
Practice Address - Phone:270-864-2555
Practice Address - Fax:270-864-3777
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4323P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY35001304Medicaid
KY000000182121OtherBCBS
KY610624096OtherCHAMPUS
KY78014206Medicaid
P00292618OtherRR MCR
KY0939009Medicare PIN
KYQ23572Medicare UPIN
KY610624096OtherCHAMPUS