Healthcare Provider Details

I. General information

NPI: 1316486293
Provider Name (Legal Business Name): TERESA MARIE KIRCHNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2017
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SIGLER AVE STE A
MEMPHIS MO
63555-1726
US

IV. Provider business mailing address

450 E SIGLER AVE STE A
MEMPHIS MO
63555-1726
US

V. Phone/Fax

Practice location:
  • Phone: 660-465-2820
  • Fax: 660-465-2956
Mailing address:
  • Phone: 660-465-2820
  • Fax: 660-465-2956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2017001660
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: