Healthcare Provider Details

I. General information

NPI: 1194237586
Provider Name (Legal Business Name): CHRISTINA CORINNE KIRKENDOLL MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 CENTRAL METHODIST SQ STE 1
FAYETTE MO
65248-1198
US

IV. Provider business mailing address

411 CENTRAL METHODIST SQ
FAYETTE MO
65248-1198
US

V. Phone/Fax

Practice location:
  • Phone: 660-248-2900
  • Fax:
Mailing address:
  • Phone: 660-248-6285
  • Fax: 660-248-6266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017034766
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: