Provider Demographics
NPI:1346765617
Name:RENFROW, KRISTINA LYNN (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINA
Middle Name:LYNN
Last Name:RENFROW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-446-5417
Mailing Address - Fax:765-446-5317
Practice Address - Street 1:975 MEZZANINE DR STE C
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-8635
Practice Address - Country:US
Practice Address - Phone:765-446-5220
Practice Address - Fax:765-446-5221
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71007347A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner