Healthcare Provider Details

I. General information

NPI: 1952252157
Provider Name (Legal Business Name): TANISHA KINGSBURY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 WASHINGTON ST
OLIVET MI
49076-9462
US

IV. Provider business mailing address

106 WASHINGTON ST
OLIVET MI
49076-9462
US

V. Phone/Fax

Practice location:
  • Phone: 269-280-6010
  • Fax:
Mailing address:
  • Phone: 269-280-6010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: