MEDICARE: MS. KRISTINA J HARRINGTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	M7142	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010002546	OTHER	ID	REGENCE BLUE SHIELD OF ID
2	DX621	OTHER	ID	BLUE CROSS OF IDAHO

General Provider Information

NPI Number	:	1407887623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINA J HARRINGTON MD

Provider Business Mailing Address
First Line	:	5985 W STATE ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-3039
Country	:	US
Telephone Number	:	208-853-0071
Fax Number	:	208-853-9422

Provider Business Practice Location Address
First Line	:	5985 W STATE ST
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83703-3039
Country	:	US
Telephone Number	:	208-853-0071
Fax Number	:	208-853-9422

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	07/08/2007

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