Healthcare Provider Details

I. General information

NPI: 1629005327
Provider Name (Legal Business Name): KRISTIN STOVERN DNP, CNM, FACNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY STE 560
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

100 MERCY WAY STE 560
JOPLIN MO
64804-4524
US

V. Phone/Fax

Practice location:
  • Phone: 417-624-2621
  • Fax: 417-624-4652
Mailing address:
  • Phone: 417-624-2621
  • Fax: 417-624-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number146706
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: