Provider Demographics
NPI:1366452344
Name:KINGSLEY, DAVID NORVAL (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:NORVAL
Last Name:KINGSLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W 39TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-2806
Mailing Address - Country:US
Mailing Address - Phone:308-865-2331
Mailing Address - Fax:308-865-2883
Practice Address - Street 1:404 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-2806
Practice Address - Country:US
Practice Address - Phone:308-865-2331
Practice Address - Fax:308-865-2883
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE17666174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist