Provider Demographics
NPI:1710648589
Name:KINGSLEY, YAZMENE DEVA
Entity Type:Individual
Prefix:
First Name:YAZMENE
Middle Name:DEVA
Last Name:KINGSLEY
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 1:11002 E BOONE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4803
Mailing Address - Country:US
Mailing Address - Phone:360-688-6500
Mailing Address - Fax:
Practice Address - Street 1:22 S THOR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-4855
Practice Address - Country:US
Practice Address - Phone:509-532-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-04
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator