Provider Demographics
NPI:1609133230
Name:KINGSLEY, DIANE (RD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 17TH ST STE W
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5687
Mailing Address - Country:US
Mailing Address - Phone:772-538-2960
Mailing Address - Fax:772-800-1050
Practice Address - Street 1:333 17TH ST STE W
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5687
Practice Address - Country:US
Practice Address - Phone:772-538-2960
Practice Address - Fax:772-800-1050
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 50325225700000X
FLND7147133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist