Individual
JOANNE RUTH KINGSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1931 HORTON RD, SUITE 8, JACKSON, MI 49203-5594
(517) 782-7510
(517) 782-7520
Mailing address
1931 HORTON RD, SUITE 8, JACKSON, MI 49203-5594
(517) 782-7510
(517) 782-7520
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
JK045630
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0720045
PHP PROVIDER NUMBER
MI
05
—
104778547
—
MI
01
—
1603811241
BCBS PROVIDER NUMBER
MI
01
—
300326016
TAX ID #
MI
Enumeration date
11/01/2006
Last updated
02/17/2021
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