Healthcare Provider Details

I. General information

NPI: 1982345419
Provider Name (Legal Business Name): KRISTINA ASSAF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 01/02/2026
Certification Date: 01/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 BODERMAN
BLOOMSDALE MO
63627-9099
US

IV. Provider business mailing address

PO BOX 366
STE GENEVIEVE MO
63670-0366
US

V. Phone/Fax

Practice location:
  • Phone: 573-483-9492
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2025030372
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: