Provider Demographics
NPI:1417304981
Name:JAYNE, KRISTINA JOY (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:JOY
Last Name:JAYNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:JOY
Other - Last Name:PESCOSOLIDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:227 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1711
Mailing Address - Country:US
Mailing Address - Phone:859-710-6300
Mailing Address - Fax:
Practice Address - Street 1:227 E MAIN ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-1711
Practice Address - Country:US
Practice Address - Phone:859-710-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-15
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL39422208000000X
KY53204208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics