Provider Demographics
NPI:1619606837
Name:KINGERY, PAIGE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:MARIE
Last Name:KINGERY
Suffix:
Gender:F
Credentials:PA-C
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 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-358-7550
Mailing Address - Fax:515-358-7551
Practice Address - Street 1:120 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-8411
Practice Address - Country:US
Practice Address - Phone:515-358-7550
Practice Address - Fax:515-358-7551
Is Sole Proprietor?:No
Enumeration Date:2022-06-06
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA123161363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program