Provider Demographics
NPI:1710715495
Name:LAFRENZ, KIRSTYN LANAE (FNP)
Entity type:Individual
Prefix:
First Name:KIRSTYN
Middle Name:LANAE
Last Name:LAFRENZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13326 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024-7250
Mailing Address - Country:US
Mailing Address - Phone:816-853-8579
Mailing Address - Fax:
Practice Address - Street 1:3351 SW 3RD ST
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-4006
Practice Address - Country:US
Practice Address - Phone:816-524-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024003457363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty