Provider Demographics
NPI:1275138430
Name:CHRISENBERY, GWENDOLYN KAY (FNP)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:KAY
Last Name:CHRISENBERY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BRIAR PL
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-5807
Mailing Address - Country:US
Mailing Address - Phone:417-438-8551
Mailing Address - Fax:
Practice Address - Street 1:5 BRIAR PL
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-5807
Practice Address - Country:US
Practice Address - Phone:417-438-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020022862363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care