Provider Demographics
NPI:1477905933
Name:ENNIS, KRISTINA AMBER (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:AMBER
Last Name:ENNIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4941 N TOWNE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8280
Mailing Address - Country:US
Mailing Address - Phone:417-551-4810
Mailing Address - Fax:417-551-4814
Practice Address - Street 1:4941 N TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8280
Practice Address - Country:US
Practice Address - Phone:417-551-4810
Practice Address - Fax:417-551-4814
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2016023152363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily