Provider Demographics
NPI:1588126007
Name:KINGSLEY, PATRICE WARE (FNP)
Entity type:Individual
Prefix:
First Name:PATRICE
Middle Name:WARE
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:PATRICE
Other - Middle Name:
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 HOSPITAL DR STE 340
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-2387
Mailing Address - Country:US
Mailing Address - Phone:318-747-2277
Mailing Address - Fax:318-747-2217
Practice Address - Street 1:2400 HOSPITAL DR STE 340
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-2387
Practice Address - Country:US
Practice Address - Phone:318-747-2277
Practice Address - Fax:318-747-2217
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA204304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner