Provider Demographics
NPI:1174523849
Name:KINGSLEY, CARLA M (DO)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:M
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:DO
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 35100
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-238-2500
Mailing Address - Fax:
Practice Address - Street 1:4119 FOX HOLLOW DR
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-6006
Practice Address - Country:US
Practice Address - Phone:406-438-1250
Practice Address - Fax:406-227-1591
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004184207RC0000X
MT11657207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000352645OtherANTHEM
OH0930738Medicaid
F09554Medicare UPIN