MEDICARE: KEVIN P KINGSLEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA3008	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386696631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN P KINGSLEY PA-C

Provider Business Mailing Address
First Line	:	2501 N ORANGE AVE STE 411
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4644
Country	:	US
Telephone Number	:	407-303-1373
Fax Number	:	407-303-0852

Provider Business Practice Location Address
First Line	:	2501 N ORANGE AVE STE 411
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-4644
Country	:	US
Telephone Number	:	407-303-1373
Fax Number	:	407-303-0852

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	11/19/2018

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