Provider Demographics
NPI:1174773592
Name:BOYD, KIMBERLY KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KRISTINE
Last Name:BOYD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:KRISTINE
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:319 LAFAYETTE ST # 151
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-2711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:319 LAFAYETTE ST # 151
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012
Practice Address - Country:US
Practice Address - Phone:000-000-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ50059207Q00000X
CODR.0054730207Q00000X
FLME131453207Q00000X
NJ25MA10001000207Q00000X
IAMD-43955207Q00000X
IN01078642A207Q00000X
MI4301111220207Q00000X
PAMD459744207Q00000X
VA0101261722207Q00000X
DCMD042916207Q00000X
MA265350207Q00000X
NC2016-01444207Q00000X
IL036129108207Q00000X
CAA112556207Q00000X
NY278623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine