Healthcare Provider Details

I. General information

NPI: 1134821036
Provider Name (Legal Business Name): SANDRA KINGSBURY AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2023
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W TERRELL AVE STE K230
FORT WORTH TX
76104-3104
US

IV. Provider business mailing address

7505 GLENVIEW DRIVE, SUITE G
NORTH RICHLAND HILLS TX
76180
US

V. Phone/Fax

Practice location:
  • Phone: 817-250-4906
  • Fax: 817-250-1815
Mailing address:
  • Phone: 817-284-9225
  • Fax: 817-590-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1110703
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: