Provider Demographics
NPI:1528092632
Name:LINEBERRY, KRISTINE L (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:L
Last Name:LINEBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:S
Other - Last Name:SHACKLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1780 NW MYHRE RD STE 1220
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8676
Mailing Address - Country:US
Mailing Address - Phone:360-813-6021
Mailing Address - Fax:
Practice Address - Street 1:1780 NW MYHRE RD STE 1220
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8676
Practice Address - Country:US
Practice Address - Phone:360-813-6021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1485542085R0202X
WI368612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32622300Medicaid
WIP00455980OtherRR MEDICARE
WIH03771Medicare UPIN
WIP00455980OtherRR MEDICARE
WI01994-0202Medicare PIN