Individual
WALTINA J KISNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APN
Contact information
Practice address
3231 S NATIONAL AVE STE 440, SPRINGFIELD, MO 65807-7304
(417) 888-5660
Mailing address
3231 S NATIONAL AVE STE 440, SPRINGFIELD, MO 65807-7304
(417) 888-5660
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
140376
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1225219009
—
MO
05
—
183029758
—
AR
01
—
431560263
TRICARE WEST
MO
01
—
P00826746
RAILROAD MCR CB9013
—
Enumeration date
11/20/2007
Last updated
04/18/2022
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