Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 139455 | MO |
NPI | 1003949587 |
---|---|
Provider Name | Mrs. Kristin C Robertson |
First Address | Lamar, MO 64759-1238 |
Second Address | Lamar, MO 64759-1238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/03/2007 |
Last Update Date | 15/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200133580A | (05) | OK |
200546830A | (05) | KS |
424028801 | (05) | MO |