MEDICARE: MRS. RUTH NASIEKU KINGOO

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	363LF0000X	Family Nurse Practitioner	R212535	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R212535	OTHER	MD	MD STATE LICENSE

General Provider Information

NPI Number	:	1689227118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTH NASIEKU KINGOO

Provider Business Mailing Address
First Line	:	2184 MOUNTAINVIEW DR
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-2813
Country	:	US
Telephone Number	:	240-431-9068
Fax Number	:

Provider Business Practice Location Address
First Line	:	5205 CHAIRMANS CT STE 201A
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21703-2918
Country	:	US
Telephone Number	:	240-629-3939
Fax Number	:	301-695-4469

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

Provider Enumeration Date	:	07/23/2019
Last Update Date	:	03/07/2023

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