Provider Demographics
NPI:1164040127
Name:CHESSMORE, KRISTI L (PSYCHOLOGIST ASSOC)
Entity type:Individual
Prefix:MRS
First Name:KRISTI
Middle Name:L
Last Name:CHESSMORE
Suffix:
Gender:F
Credentials:PSYCHOLOGIST ASSOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3828
Mailing Address - Country:US
Mailing Address - Phone:308-534-4872
Mailing Address - Fax:
Practice Address - Street 1:306 W 4TH ST
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3828
Practice Address - Country:US
Practice Address - Phone:308-534-4872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2016004627103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool