Healthcare Provider Details

I. General information

NPI: 1336074319
Provider Name (Legal Business Name): KALI JEAN KINGSLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 E MADISON ST
SPRINGFIELD IL
62701-1035
US

IV. Provider business mailing address

PO BOX 19642
SPRINGFIELD IL
62794-9642
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-7627
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number125087839
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: