MEDICARE: CARLA M KINGSLEY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	34004184	OH
2	207RC0000X	Cardiovascular Disease Physician	11657	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000352645	OTHER	OH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174523849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLA M KINGSLEY DO

Provider Business Mailing Address
First Line	:	PO BOX 35100
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59107-5100
Country	:	US
Telephone Number	:	406-238-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 FOX HOLLOW DR
Second Line	:
City	:	HELENA
State	:	MT
Zip	:	59602-6006
Country	:	US
Telephone Number	:	406-438-1250
Fax Number	:	406-227-1591

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	02/28/2022

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