Provider Demographics
NPI:1174580419
Name:KINGSLEY, KHRISTEENA R (CNM)
Entity type:Individual
Prefix:MS
First Name:KHRISTEENA
Middle Name:R
Last Name:KINGSLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-474-2816
Mailing Address - Fax:716-371-1345
Practice Address - Street 1:4500 HARLEM RD
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-474-2816
Practice Address - Fax:716-371-1345
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-28
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF0010561367A00000X
NYF001056-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8494418Medicaid
NY02747648Medicaid
NYP85757Medicare UPIN
NYDD5091Medicare ID - Type Unspecified
NY8494418Medicaid
P85757Medicare UPIN