Provider Demographics
NPI:1326640343
Name:KINGSHOTT, KEVIN (DNP-FNP)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:KINGSHOTT
Suffix:
Gender:M
Credentials:DNP-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 E VAN RIPER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FOWLERVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48836-7947
Mailing Address - Country:US
Mailing Address - Phone:517-223-7900
Mailing Address - Fax:517-223-7635
Practice Address - Street 1:202 E VAN RIPER RD STE 100
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-7947
Practice Address - Country:US
Practice Address - Phone:517-223-7900
Practice Address - Fax:517-223-7635
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704177532163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse