Provider Demographics
NPI:1811265382
Name:KINGSLEY, VALERIE LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:VALERIE
Middle Name:LYNN
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:RN
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 102
Mailing Address - Street 2:2578 GENESEE STREET
Mailing Address - City:RETSOF
Mailing Address - State:NY
Mailing Address - Zip Code:14539-0102
Mailing Address - Country:US
Mailing Address - Phone:585-243-1730
Mailing Address - Fax:585-243-4267
Practice Address - Street 1:2578 GENESEE ST
Practice Address - Street 2:
Practice Address - City:RETSOF
Practice Address - State:NY
Practice Address - Zip Code:14539
Practice Address - Country:US
Practice Address - Phone:585-243-1730
Practice Address - Fax:585-243-4267
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-12
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY546120163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse