Healthcare Provider Details

I. General information

NPI: 1972529709
Provider Name (Legal Business Name): KRISTIN ANTONY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 08/25/2021
Certification Date: 08/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S COLLEGE AVE
WARRENSBURG MO
64093-2626
US

IV. Provider business mailing address

757 ARMSTRONG AVE
KANSAS CITY KS
66101-2701
US

V. Phone/Fax

Practice location:
  • Phone: 660-543-4777
  • Fax: 660-543-8222
Mailing address:
  • Phone: 913-233-3300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2018028451
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number74647
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: