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Individual
KIRSTIN JENNA RUSSELL
Active
Individual
KIRSTIN JENNA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
2025040266
MO
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
71011436A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001614748
ANTHEM PTAN
IN
01
—
1102264002
ANTHEM PTAN
IN
01
—
264430D16
MEDICARE PTAN
IN
05
—
300055577
—
IN
01
—
Q00332599
RAILROAD PTAN
IN
Enumeration date
08/10/2021
Last updated
12/10/2025
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