Provider Demographics
NPI:1144831124
Name:JENNINGS, KRISTIN R (DNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:JENNINGS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:R
Other - Last Name:MEINERSHAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 959354
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63195-5729
Mailing Address - Country:US
Mailing Address - Phone:573-705-7870
Mailing Address - Fax:314-273-0123
Practice Address - Street 1:513 W PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1439
Practice Address - Country:US
Practice Address - Phone:573-705-7870
Practice Address - Fax:314-273-0123
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020024770363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily