Provider Demographics
NPI:1487497632
Name:KINGSTON, KELLY LYNN (ARNP FNP- BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:KINGSTON
Suffix:
Gender:F
Credentials:ARNP FNP- BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 29TH STREET PL SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-4019
Mailing Address - Country:US
Mailing Address - Phone:253-219-0407
Mailing Address - Fax:
Practice Address - Street 1:2505 S 38TH ST STE 109
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-7372
Practice Address - Country:US
Practice Address - Phone:253-319-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61561955363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner