Individual
MIMI ANN KINGERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5147 N 9TH AVE STE 311, PENSACOLA, FL 32504-8770
(850) 477-2597
(850) 478-7941
Mailing address
4828 N DAVIS HWY, PENSACOLA, FL 32503-2341
(850) 477-8109
(850) 478-2412
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9106214
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000132945
—
FL
01
—
FO262Z
MCR
FL
01
—
Y08Z7
BCBS
FL
Enumeration date
08/18/2011
Last updated
04/11/2018
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