Individual
KRISTIN LYNN DIETIKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
303 N. KEENE ST., SUITE 404, COLUMBIA, MO 65201
(573) 777-7627
(573) 777-4596
Mailing address
PO BOX 505164, SAINT LOUIS, MO 63150-5164
(417) 820-2000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2014008188
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
MO
Enumeration date
04/19/2011
Last updated
08/06/2016
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