Provider Demographics
NPI:1508127606
Name:LINGAFELTER, KENT L/ (NP)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:L/
Last Name:LINGAFELTER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:MR
Other - First Name:KENTON
Other - Middle Name:L
Other - Last Name:LINGAFELTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACNP
Mailing Address - Street 1:8950 S 52ND ST STE 107
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1042
Mailing Address - Country:US
Mailing Address - Phone:480-543-2034
Mailing Address - Fax:480-590-6897
Practice Address - Street 1:8950 S 52ND ST STE 107
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1042
Practice Address - Country:US
Practice Address - Phone:480-590-2451
Practice Address - Fax:480-590-6897
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN098048163W00000X
AZAP8967363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse