Provider Demographics
NPI:1932854932
Name:KINGSLAND, KAM (APRN, PMHNP)
Entity Type:Individual
Prefix:
First Name:KAM
Middle Name:
Last Name:KINGSLAND
Suffix:
Gender:M
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 E BAARS ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-4149
Mailing Address - Country:US
Mailing Address - Phone:850-341-0045
Mailing Address - Fax:
Practice Address - Street 1:308 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5969
Practice Address - Country:US
Practice Address - Phone:850-807-0138
Practice Address - Fax:850-361-2128
Is Sole Proprietor?:No
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11018209363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health