Provider Demographics
NPI:1346712379
Name:KINGSLEY, WENDY (APRN)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:FORT MC COY
Mailing Address - State:FL
Mailing Address - Zip Code:32134-0479
Mailing Address - Country:US
Mailing Address - Phone:352-236-2525
Mailing Address - Fax:352-236-8610
Practice Address - Street 1:15035 NE HIGHWAY 315
Practice Address - Street 2:
Practice Address - City:FORT MC COY
Practice Address - State:FL
Practice Address - Zip Code:32134-2200
Practice Address - Country:US
Practice Address - Phone:352-236-2525
Practice Address - Fax:352-236-8610
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11000784363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily