Provider Demographics
NPI:1013159383
Name:BOYETTE, KRISTINA G (APN)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:G
Last Name:BOYETTE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 COVINGTON PIKE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38135-2209
Mailing Address - Country:US
Mailing Address - Phone:901-386-1625
Mailing Address - Fax:901-377-8986
Practice Address - Street 1:3809 COVINGTON PIKE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38135-2209
Practice Address - Country:US
Practice Address - Phone:901-386-1625
Practice Address - Fax:901-377-8986
Is Sole Proprietor?:No
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6415961363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily