Healthcare Provider Details

I. General information

NPI: 1427136472
Provider Name (Legal Business Name): JOANNE KINGSLEY MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1931 HORTON RD SUITE 8
JACKSON MI
49203-5594
US

IV. Provider business mailing address

1931 HORTON RD SUITE 8
JACKSON MI
49203-5594
US

V. Phone/Fax

Practice location:
  • Phone: 517-782-7510
  • Fax: 517-782-7520
Mailing address:
  • Phone: 517-782-7510
  • Fax: 517-782-7520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOANNE RUTH KINGSLEY
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 517-796-4775