Provider Demographics
NPI:1043251291
Name:BOYD, KRISTINE DEE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:DEE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:DEE
Other - Last Name:PASUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:853 N CHURCH ST STE 700
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303
Practice Address - Country:US
Practice Address - Phone:864-560-6164
Practice Address - Fax:864-560-7092
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-02235207V00000X
SC21859207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC57-6007863031OtherBCBS OF SC
SCT60092Medicaid
NC2022-02235OtherNC MED LIC
SC7212119OtherAETNA
SC57-6007863031OtherBLUE CHOICE OF SC
SCP00247045OtherRR MEDICARE
SCSCA7353365OtherMEDICARE PIN
SCH217767951Medicare PIN