Provider Demographics
NPI:1477957082
Name:KINGSLEY, JOSEPH EDGAR (RN)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:EDGAR
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17A SKYLARK DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-5176
Mailing Address - Country:US
Mailing Address - Phone:518-791-6905
Mailing Address - Fax:
Practice Address - Street 1:17A SKYLARK DR
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803-5176
Practice Address - Country:US
Practice Address - Phone:518-791-6905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY622659163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse