Provider Demographics
NPI:1689710899
Name:KINGSTON, GREGORY D (APRN)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:D
Last Name:KINGSTON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 S 2ND ST
Mailing Address - Street 2:PO BOX 497
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-2309
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:125 S 20TH ST
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-7100
Practice Address - Country:US
Practice Address - Phone:270-575-3247
Practice Address - Fax:270-442-7335
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3002602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6592143900Medicaid
KYP01026376OtherRAILROAD MEDICARE LPS
KY78900180Medicaid
KY78260205Medicaid
KY78900180Medicaid
KYP01026376OtherRAILROAD MEDICARE LPS
KY0266112Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
KY78260205Medicaid