Healthcare Provider Details

I. General information

NPI: 1730684515
Provider Name (Legal Business Name): KRISTIN CAMILLE BUBEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 PATEWOOD DR STE 130
GREENVILLE SC
29615-6317
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-455-8988
  • Fax: 864-455-4540
Mailing address:
  • Phone: 864-522-8603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number87339
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: