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Individual

MRS. KRISTEN ELAINE JEANS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
ATC, LMT

Contact information

Practice address
2520 HOPEWELL RD, WENTZVILLE, MO 63385-5911
(636) 346-2104
Mailing address
2520 HOPEWELL RD, WENTZVILLE, MO 63385-5911
(636) 346-2104

Taxonomy

Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2004030353
MO
225700000X
Massage Therapist
2007035482
MO

Other

Enumeration date
11/02/2009
Last updated
06/06/2019
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