Provider Demographics
NPI:1407906324
Name:BOYCE, KRISTEN B (DPM)
Entity Type:Individual
Prefix:MR
First Name:KRISTEN
Middle Name:B
Last Name:BOYCE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3802 BROADWAY
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-5032
Mailing Address - Country:US
Mailing Address - Phone:425-259-0855
Mailing Address - Fax:425-259-0856
Practice Address - Street 1:3802 BROADWAY
Practice Address - Street 2:SUITE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5032
Practice Address - Country:US
Practice Address - Phone:425-259-0855
Practice Address - Fax:425-259-0856
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO60567259213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01004688Medicaid
U50402Medicare UPIN
COC447458Medicare PIN