Doctor Name: | JENNIFER KINGSBURY |
NPI Number: | 1255677738 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 5601003220 |
Business Practice Address: | 13105 Schavey Rd #4 Dewitt, MI - 488209037 |
Business Phone Number: | 5176680555 |
Business Fax Number: | |
Mailing Address: | 1701 Lake Lansing Rd, Suite 100 LANSING |
State: | MI |
Postal Code: | 489123798 |
Phone Number: | 5174850001 |
Fax Number: | |
NPI Enumeration Date: | 01/02/2013 |
NPI Last Update Date: | 01/02/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 5601003220 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MI |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |