Individual
KRISTEN ANNE THEOBALD-HAZEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1057 MEDICAL PARK DR, OSAGE BEACH, MO 65065-3000
(573) 302-3100
(573) 348-8279
Mailing address
54 HOSPITAL DR, OSAGE BEACH, MO 65065-3050
(573) 302-3100
(573) 348-8279
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2009001633
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1447229489
—
MO
Enumeration date
09/01/2006
Last updated
09/02/2021
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