Provider Demographics
NPI:1003949587
Name:ROBERTSON, KRISTIN C (RN FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:C
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 GULF ST.
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:MO
Mailing Address - Zip Code:64759-1238
Mailing Address - Country:US
Mailing Address - Phone:417-682-5508
Mailing Address - Fax:417-682-5594
Practice Address - Street 1:805 GULF ST.
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:MO
Practice Address - Zip Code:64759-1238
Practice Address - Country:US
Practice Address - Phone:417-682-5508
Practice Address - Fax:417-682-5594
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO139455363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO424028801Medicaid
KS200546830AMedicaid
OK200133580AMedicaid
MO424028801Medicaid
P00461883Medicare PIN