Healthcare Provider Details

I. General information

NPI: 1730609231
Provider Name (Legal Business Name): DIANE KINGSLEY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 17TH ST STE N
VERO BEACH FL
32960-5686
US

IV. Provider business mailing address

333 17TH ST STE N
VERO BEACH FL
32960-5686
US

V. Phone/Fax

Practice location:
  • Phone: 772-228-6778
  • Fax: 772-800-1050
Mailing address:
  • Phone: 772-538-2960
  • Fax: 772-800-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DIANE KINGSLEY
Title or Position: CEO
Credential: RD LDN
Phone: 772-538-2960