Healthcare Provider Details

I. General information

NPI: 1912977679
Provider Name (Legal Business Name): KRISTINA D. BURTON-VUNESKY MSW, LCSW, PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTINA D. BURTON MSW, LCSW, PSY.D.

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 03/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 W CENTER CIR SUITE 103
NIXA MO
65714-7001
US

IV. Provider business mailing address

729 W CENTER CIR SUITE 103
NIXA MO
65714-7001
US

V. Phone/Fax

Practice location:
  • Phone: 417-724-0700
  • Fax: 417-724-0710
Mailing address:
  • Phone: 417-724-0700
  • Fax: 417-724-0710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004005435
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2008009366
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number2008009366
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier496125006
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 2
Identifier9567100
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerAETNA
# 3
Identifier201291
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerBLUE CROSS BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: