Provider Demographics
NPI:1760096663
Name:KINGSTON, GARRET RYAN
Entity Type:Individual
Prefix:
First Name:GARRET
Middle Name:RYAN
Last Name:KINGSTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 RIVERFRONT ST APT 423
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-2989
Mailing Address - Country:US
Mailing Address - Phone:812-360-8893
Mailing Address - Fax:
Practice Address - Street 1:998 RIVERFRONT ST APT 423
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-2989
Practice Address - Country:US
Practice Address - Phone:812-360-8893
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant