Provider Demographics
NPI:1881335040
Name:KINGSLEY, CHARLOTTE LUCY (ARNP)
Entity type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:LUCY
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:LUCY
Other - Last Name:HOOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:975 SE 11TH AVE APT 514
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2491
Mailing Address - Country:US
Mailing Address - Phone:850-420-9988
Mailing Address - Fax:
Practice Address - Street 1:400 NE MOTHER JOSEPH PL
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-3200
Practice Address - Country:US
Practice Address - Phone:360-514-3727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-03
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202000807363LA2100X
WAAP61134426363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care