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NPI Code Detail

MEDICARE: KRISTINA AMBER ENNIS FNP-BC

MEDICARE: KRISTINA AMBER ENNIS FNP-BC
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
1363LF0000XFamily Nurse Practitioner2016023152MO

General Provider Information

NPI Number : 1477905933
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA AMBER ENNIS FNP-BC
Provider Business Mailing Address
First Line : 4941 N TOWNE CENTRE DR
Second Line :
City : OZARK
State : MO
Zip : 65721-8280
Country : US
Telephone Number : 417-551-4810
Fax Number : 417-551-4814
Provider Business Practice Location Address
First Line : 4941 N TOWNE CENTRE DR
Second Line :
City : OZARK
State : MO
Zip : 65721-8280
Country : US
Telephone Number : 417-551-4810
Fax Number : 417-551-4814
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2016
Last Update Date : 12/09/2019

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Directions to “ KRISTINA AMBER ENNIS FNP-BC” Practice Location

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