# KIRSTIN JENNA RUSSELL

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1700551918
- **Gender:** F
- **Credential:** PMHNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 2025040266 | MO | Yes |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 71011436A | IN | — |

## Other

- **Enumeration date:** 08/10/2021
- **Last updated:** 12/10/2025

## 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 |