Healthcare Provider Details

I. General information

NPI: 1144679960
Provider Name (Legal Business Name): KRISTEN ALLCORN KILLEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2016
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N OLD WILDERNESS RD
NIXA MO
65714-9490
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 417-269-2227
  • Fax: 417-269-2235
Mailing address:
  • Phone: 417-730-6430
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2019009694
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: