Peter Kingsley, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW61205441 Issued in WA

Practice address

10 Missile Ave
Minot AFB, ND 58705-5003

Phone

(701) 723-5633

NPI assigned

Jul 10, 2018

Last updated

Jan 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1531180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1679069843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 MISSILE AVE",
            "city": "MINOT AFB",
            "state": "ND",
            "postal_code": "587055003",
            "telephone_number": "701-723-5633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MISSILE AVE",
            "city": "MINOT AFB",
            "state": "ND",
            "postal_code": "587055003",
            "telephone_number": "701-723-5633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGSLEY",
        "first_name": "PETER",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-10",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW61205441",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "14615066",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Patricia Ann Hostyn, DMD
• Caleb James, D.O.
• Deborah K Jones, PNP
• Kiernan Judd
• Enoch Kimmel
• Kelly Jean Kitts
• James W Koll, DDS
• Lisa Krogman, FNP-C
• Zsuzsanna Danuta Krokovay, PA
• Andrea Marie Larocque, PA-C

• Clinical Social Worker in Minot AFB, ND
• Providers in Minot AFB, ND by specialty
• Clinical Social Worker in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.