Healthcare Provider Details

I. General information

NPI: 1720911365
Provider Name (Legal Business Name): ZACKARY KINGSLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1804 PIONEER RD
LANCASTER PA
17602-1518
US

IV. Provider business mailing address

1804 PIONEER RD
LANCASTER PA
17602-1518
US

V. Phone/Fax

Practice location:
  • Phone: 717-419-0377
  • Fax:
Mailing address:
  • Phone: 717-419-0377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: