Provider Demographics
NPI:1124070768
Name:HURSEY, KRISTINA P (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:P
Last Name:HURSEY
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:PO BOX 896239
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-6239
Mailing Address - Country:US
Mailing Address - Phone:803-865-2122
Mailing Address - Fax:
Practice Address - Street 1:21 GATEWAY CORNERS PARK
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-8906
Practice Address - Country:US
Practice Address - Phone:803-865-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0762207R00000X
SC31369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00382491OtherRAILROAD MEDICARE PTAN
TXM0762OtherSTATE LICENSE #
TXI36984Medicare UPIN
TXM0762OtherSTATE LICENSE #
8F0678Medicare PIN