Provider Demographics
NPI:1629477757
Name:DUKES, KINGSLEA MOORE (NP)
Entity Type:Individual
Prefix:DR
First Name:KINGSLEA
Middle Name:MOORE
Last Name:DUKES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:DR
Other - First Name:MARGARET
Other - Middle Name:KINGSLEA
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:724 S SHELMORE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-1602
Mailing Address - Country:US
Mailing Address - Phone:843-936-2036
Mailing Address - Fax:
Practice Address - Street 1:724 S SHELMORE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-1602
Practice Address - Country:US
Practice Address - Phone:843-936-2036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily