Healthcare Provider Details

I. General information

NPI: 1295462778
Provider Name (Legal Business Name): KINSTON CUMMINGS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5144 HILL RD E
LAKEPORT CA
95453-6300
US

IV. Provider business mailing address

4700 EXCHANGE CT STE 110
BOCA RATON FL
33431-4450
US

V. Phone/Fax

Practice location:
  • Phone: 707-263-8955
  • Fax: 707-263-8340
Mailing address:
  • Phone: 561-948-0291
  • Fax: 561-859-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number61469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: