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General NPI Number Information
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NPI Number | 1699967976
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Entity Type | Individual
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Provider Name | KRISTIN JOAN FLYNN PETERS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2007
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 315 BUSINESS LOOP 70 W HOWARD A. RUSK REHABILITATION CENTER, HEALTH PSYCHOLOGY
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City | COLUMBIA
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State | MO
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Zip | 65203-3248
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Country | US
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Telephone | 573-882-8876
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Fax | 573-884-3518
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Provider Business Mailing Address
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Address Line | PO BOX 7687
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City | COLUMBIA
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State | MO
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Zip | 65205-7687
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Country | US
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Telephone | 573-882-2259
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2009031637
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071006055
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License Number State | IL
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