Individual
MS. KRISTIN ANN TIVENER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MET, ATC
Contact information
Practice address
901 S NATIONAL AVE, SPRINGFIELD, MO 65897-0027
(630) 621-0709
Mailing address
901 S NATIONAL AVE, SPRINGFIELD, MO 65897-0027
(630) 621-0709
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
36001176A
IN
2255A2300X
Athletic Trainer
Primary
2011013606
MO
Other
Enumeration date
07/10/2006
Last updated
10/30/2015
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