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Individual

KRISTINE WALL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1511 CHRISTY DR, JEFFERSON CITY, MO 65101-2854
(573) 632-2777
(573) 632-2769
Mailing address
PO BOX 104780, JEFFERSON CITY, MO 65110-4780

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2024015564
MO

Other

Enumeration date
05/03/2024
Last updated
05/03/2024
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