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General NPI Number Information
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NPI Number | 1225466972
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Entity Type | Organization
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Legal Business Name | JOHN KINGSLEY MD PLLC
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Dates
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Enumeration Date | 10/16/2013
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Last Update Date | 03/10/2014
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Provider Practice Location Address
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Address Line | 3555 S VAL VISTA DR
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City | GILBERT
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State | AZ
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Zip | 85297-7323
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Country | US
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Telephone | 602-374-5610
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 11706
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City | GLENDALE
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State | AZ
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Zip | 85318-1706
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | JOHN KINGSLEY
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Credential | MD
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Telephone | 602-374-5610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 35465
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License Number State | AZ
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