Healthcare Provider Details

I. General information

NPI: 1811950900
Provider Name (Legal Business Name): KRISTA L KOINZAN-BOYD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 10/16/2023
Certification Date: 10/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S MAIN ST
ROGERSVILLE MO
65742-9357
US

IV. Provider business mailing address

101 S MAIN ST
ROGERSVILLE MO
65742-9357
US

V. Phone/Fax

Practice location:
  • Phone: 417-753-9404
  • Fax: 417-753-9137
Mailing address:
  • Phone: 417-753-9404
  • Fax: 417-753-9137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number108854
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: