Provider Demographics
NPI:1720426844
Name:KINGSLEY, KATHLEEN VIRGINIA
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:VIRGINIA
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:KINGSLEY
Other - Last Name:JACOBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MRP
Mailing Address - Street 1:1303 OAKMONT RD
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-2065
Mailing Address - Country:US
Mailing Address - Phone:570-587-1699
Mailing Address - Fax:579-587-1532
Practice Address - Street 1:1303 OAKMONT RD
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-2065
Practice Address - Country:US
Practice Address - Phone:570-587-1699
Practice Address - Fax:579-587-1532
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist