Provider Demographics
NPI:1083940696
Name:JEANS, KRISTEN ELAINE (ATC, LMT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:ELAINE
Last Name:JEANS
Suffix:
Gender:F
Credentials:ATC, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 HOPEWELL RD
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-5911
Mailing Address - Country:US
Mailing Address - Phone:636-346-2104
Mailing Address - Fax:
Practice Address - Street 1:2520 HOPEWELL RD
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-5911
Practice Address - Country:US
Practice Address - Phone:636-346-2104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-02
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007035482225700000X
MO20040303532255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist