Healthcare Provider Details

I. General information

NPI: 1053399774
Provider Name (Legal Business Name): KRISTINA LYNN POST O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA L NELLIS OD

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 03/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2508 EDGEMONT DR SUITE 6
ARKANSAS CITY KS
67005-3844
US

IV. Provider business mailing address

2508 EDGEMONT DR SUITE #6
ARKANSAS CITY KS
67005-3844
US

V. Phone/Fax

Practice location:
  • Phone: 620-442-2577
  • Fax: 620-442-2578
Mailing address:
  • Phone: 620-442-2577
  • Fax: 620-442-2578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1691
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: