Provider Demographics
NPI:1003267865
Name:KINGSLEY, ANTHONY M (FNP)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:M
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 PERKINS LN
Mailing Address - Street 2:
Mailing Address - City:JACKSBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37757-2833
Mailing Address - Country:US
Mailing Address - Phone:423-500-9140
Mailing Address - Fax:423-435-0828
Practice Address - Street 1:163 PERKINS LN
Practice Address - Street 2:
Practice Address - City:JACKSBORO
Practice Address - State:TN
Practice Address - Zip Code:37757-2833
Practice Address - Country:US
Practice Address - Phone:423-500-9140
Practice Address - Fax:423-435-0828
Is Sole Proprietor?:No
Enumeration Date:2016-06-23
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily