MEDICARE: MRS. KRISTIN C ROBERTSON RN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LC0200X	Critical Care Medicine Nurse Practitioner	139455	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003949587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTIN C ROBERTSON RN FNP-C

Provider Business Mailing Address
First Line	:	805 GULF ST.
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1238
Country	:	US
Telephone Number	:	417-682-5508
Fax Number	:	417-682-5594

Provider Business Practice Location Address
First Line	:	805 GULF ST.
Second Line	:
City	:	LAMAR
State	:	MO
Zip	:	64759-1238
Country	:	US
Telephone Number	:	417-682-5508
Fax Number	:	417-682-5594

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	02/15/2012

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