Provider Demographics
NPI:1417283557
Name:KINGSLEY, LISA ANN (LMP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7321 58TH STREET CT W
Mailing Address - Street 2:#303
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-4723
Mailing Address - Country:US
Mailing Address - Phone:253-302-6447
Mailing Address - Fax:
Practice Address - Street 1:7321 58TH STREET CT W
Practice Address - Street 2:#303
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-4723
Practice Address - Country:US
Practice Address - Phone:253-302-6447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-24
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60101493174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist