Provider Demographics
NPI:1922067800
Name:BEAUCHAMP, KRISTINE LYNNE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:LYNNE
Last Name:BEAUCHAMP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-1830
Mailing Address - Country:US
Mailing Address - Phone:830-249-9307
Mailing Address - Fax:830-249-8227
Practice Address - Street 1:120 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-249-9307
Practice Address - Fax:830-249-8227
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157883305Medicaid
TX8M7999OtherBLUE SHIELD
TXP00195396OtherRR/MEDICARE
TX8M7999OtherBLUE SHIELD
TXP00195396OtherRR/MEDICARE
TXH83628Medicare UPIN