Healthcare Provider Details

I. General information

NPI: 1194631473
Provider Name (Legal Business Name): KIMBERLY TURNER KINGSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLD COURT RD STE 205
PIKESVILLE MD
21208-2800
US

IV. Provider business mailing address

4000 OLD COURT RD STE 205
PIKESVILLE MD
21208-2800
US

V. Phone/Fax

Practice location:
  • Phone: 410-484-9950
  • Fax: 410-484-9953
Mailing address:
  • Phone: 410-484-9950
  • Fax: 410-484-9953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR203815
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: