Individual
KIRSTIE R. RECKTENWALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1409 DOCTORS DR, WEST PLAINS, MO 65775-4754
(417) 255-1373
Mailing address
1409 DOCTORS DR, WEST PLAINS, MO 65775-4754
(417) 255-1373
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
2013024398
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023441672
—
MO
Enumeration date
08/19/2013
Last updated
09/10/2020
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