Provider Demographics
NPI:1437676202
Name:PINHEIRO, KRISTIN HARTER (PA)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:HARTER
Last Name:PINHEIRO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-515-7500
Mailing Address - Fax:864-515-7500
Practice Address - Street 1:333 S PINE ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-2622
Practice Address - Country:US
Practice Address - Phone:864-515-7500
Practice Address - Fax:864-515-7501
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
SCTL2866363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program