Healthcare Provider Details

I. General information

NPI: 1861355562
Provider Name (Legal Business Name): JEANINE ALYCE KINGSBURY BHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 SAN DIEGO RD
JACKSONVILLE FL
32207-3691
US

IV. Provider business mailing address

4463 CARRIAGE CROSSING DR
JACKSONVILLE FL
32258-1307
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-7744
  • Fax: 888-469-0248
Mailing address:
  • Phone: 727-846-3938
  • Fax: 888-469-0248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: