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General NPI Number Information
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NPI Number | 1912417569
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Entity Type | Individual
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Provider Name | KRISTEN HERINA APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/10/2017
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Last Update Date | 10/10/2017
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Provider Practice Location Address
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Address Line | 106 BROADWAY ST
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City | ELSBERRY
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State | MO
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Zip | 63343-1345
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Country | US
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Telephone | 573-898-9100
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Fax |
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Provider Business Mailing Address
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Address Line | 706 LONGHORN DR
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City | O FALLON
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State | MO
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Zip | 63368-6961
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Country | US
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Telephone | 636-448-4733
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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 | 2017036302
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License Number State | MO
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