Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 21300 | TN |
NPI | 1003267865 |
---|---|
Provider Name | Anthony M. Kingsley |
First Address | Knoxville, TN 37909-2604 |
Second Address | Jacksboro, TN 37757-4847 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2016 |
Last Update Date | 23/06/2016 |