MEDICARE: KRISTEN LYNN MAIN FNP-C

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	363LF0000X	Family Nurse Practitioner	2016013313	MO

General Provider Information

NPI Number	:	1083163505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN LYNN MAIN FNP-C

Provider Business Mailing Address
First Line	:	12639 OLD TESSON RD STE 100
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63128-2711
Country	:	US
Telephone Number	:	314-849-0311
Fax Number	:	314-849-4423

Provider Business Practice Location Address
First Line	:	2121 BARRETT STATION RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1606
Country	:	US
Telephone Number	:	314-394-1923
Fax Number	:

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

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	08/19/2025

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