Provider Demographics
NPI:1013704386
Name:DUROSSETTE, KINSLEY
Entity type:Individual
Prefix:
First Name:KINSLEY
Middle Name:
Last Name:DUROSSETTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KINSLEY
Other - Middle Name:
Other - Last Name:STEWART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:865 145TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-8505
Mailing Address - Country:US
Mailing Address - Phone:417-317-7265
Mailing Address - Fax:
Practice Address - Street 1:1014 MT CARMEL PL
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762
Practice Address - Country:US
Practice Address - Phone:620-235-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-04157225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant