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General NPI Number Information
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NPI Number | 1245726710
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Entity Type | Individual
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Provider Name | KRISTEN RIDER APRN, NP-C
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Gender | Female
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Dates
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Enumeration Date | 07/07/2018
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 1400 US HIGHWAY 61 STE 210
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City | FESTUS
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State | MO
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Zip | 63028-4141
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Country | US
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Telephone | 636-933-8880
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Fax | 636-933-8881
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Provider Business Mailing Address
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Address Line | 2211 CARLTON DR
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City | FESTUS
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State | MO
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Zip | 63028-3807
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Country | US
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Telephone | 314-724-7879
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2018023790
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License Number State | MO
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