Provider Demographics
NPI:1295381556
Name:SKINNER, KRISTINA CAMBA (FNP)
Entity Type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:CAMBA
Last Name:SKINNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-996-8670
Mailing Address - Fax:314-996-3195
Practice Address - Street 1:10 BARNES WEST DR
Practice Address - Street 2:DIV IM ALLERGY AND IMMUNOLOGY, STE 200
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6287
Practice Address - Country:US
Practice Address - Phone:314-996-8670
Practice Address - Fax:314-996-3195
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019035506363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO420077330Medicaid