Provider Demographics
NPI:1689227118
Name:KINGOO, RUTH NASIEKU
Entity Type:Individual
Prefix:MRS
First Name:RUTH
Middle Name:NASIEKU
Last Name:KINGOO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2184 MOUNTAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-2813
Mailing Address - Country:US
Mailing Address - Phone:240-431-9068
Mailing Address - Fax:
Practice Address - Street 1:5205 CHAIRMANS CT STE 201A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-2918
Practice Address - Country:US
Practice Address - Phone:240-629-3939
Practice Address - Fax:301-695-4469
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR212535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR212535OtherMD STATE LICENSE
MDR212535OtherMD STATE LICENSE