Basic Information
Provider Information
NPI: 1437483799
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KINGSLEY
FirstName: CARRIE
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 ORONDO AVE
Address2: STE. 1
City: WENATCHEE
State: WA
PostalCode: 988012800
CountryCode: US
TelephoneNumber: 5096643527
FaxNumber: 5096644590
Practice Location
Address1: 600 ORONDO AVE
Address2: STE. 1
City: WENATCHEE
State: WA
PostalCode: 988012800
CountryCode: US
TelephoneNumber: 5096626000
FaxNumber: 5096644588
Other Information
ProviderEnumerationDate: 09/18/2009
LastUpdateDate: 09/18/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP60113463WAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


Home