MEDICARE: CAROLINE KINGSTON MD

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	207Q00000X	Family Medicine Physician	97-89	NM

General Provider Information

NPI Number	:	1750489811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE KINGSTON MD

Provider Business Mailing Address
First Line	:	460 SAINT MICHAELS DR
Second Line	:	SUITE 1104
City	:	SANTA FE
State	:	NM
Zip	:	87505-7619
Country	:	US
Telephone Number	:	505-820-2562
Fax Number	:	505-795-7123

Provider Business Practice Location Address
First Line	:	460 SAINT MICHAELS DR
Second Line	:	SUITE 1104
City	:	SANTA FE
State	:	NM
Zip	:	87505-7619
Country	:	US
Telephone Number	:	505-820-2562
Fax Number	:	505-795-7123

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	12/19/2023

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Directions to “ CAROLINE KINGSTON MD” Practice Location

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