Provider Demographics
NPI:1487844775
Name:BUSSEY-SMITH, KRISTIN L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:L
Last Name:BUSSEY-SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19260 STONE OAK PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3365
Mailing Address - Country:US
Mailing Address - Phone:210-495-4335
Mailing Address - Fax:210-587-7415
Practice Address - Street 1:19260 STONE OAK PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3365
Practice Address - Country:US
Practice Address - Phone:210-495-4335
Practice Address - Fax:210-587-7415
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM5080207K00000X, 207KA0200X, 207R00000X, 207RA0201X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191307101Medicaid
TX191307101Medicaid