Individual
KRISTEN ALICE DERDERIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNP
Contact information
Practice address
12200 WEBER HILL RD STE 100, SAINT LOUIS, MO 63127-1599
(314) 698-2500
(314) 698-2323
Mailing address
12200 WEBER HILL RD STE 100, SAINT LOUIS, MO 63127-1599
(314) 698-2500
(508) 823-5689
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
2021013574
MO
363LP2300X
Primary Care Nurse Practitioner
RN2321686
MA
Other
Enumeration date
06/27/2019
Last updated
03/21/2022
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