Provider Demographics
NPI:1770672891
Name:MINOR, KINGSLEY (PT)
Entity Type:Individual
Prefix:
First Name:KINGSLEY
Middle Name:
Last Name:MINOR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1390
Mailing Address - Street 2:
Mailing Address - City:CULLOWHEE
Mailing Address - State:NC
Mailing Address - Zip Code:28723-1390
Mailing Address - Country:US
Mailing Address - Phone:828-586-7000
Mailing Address - Fax:
Practice Address - Street 1:68 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-2722
Practice Address - Country:US
Practice Address - Phone:828-586-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3809282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3809OtherSTATE LICENSE