Healthcare Provider Details

I. General information

NPI: 1922309327
Provider Name (Legal Business Name): JAMES KINGSLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2010
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 W 1000 N
LOGAN UT
84321-2240
US

IV. Provider business mailing address

88 W 1000 N
LOGAN UT
84321-2240
US

V. Phone/Fax

Practice location:
  • Phone: 435-753-9046
  • Fax: 435-787-9140
Mailing address:
  • Phone: 435-753-9046
  • Fax: 435-787-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: