Provider Demographics
NPI:1437217593
Name:WENGER, KRISTINA MICHELE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:MICHELE
Last Name:WENGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4000 LINWOOD DR
Mailing Address - Street 2:SUITE H
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7223
Mailing Address - Country:US
Mailing Address - Phone:870-236-7337
Mailing Address - Fax:870-236-7332
Practice Address - Street 1:4000 LINWOOD DR
Practice Address - Street 2:SUITE H
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-7223
Practice Address - Country:US
Practice Address - Phone:870-236-7337
Practice Address - Fax:870-236-7332
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE3680208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149755001Medicaid
AR5M546OtherBLUE CROSS
ARH88332Medicare UPIN