Provider Demographics
NPI:1558912824
Name:DEHNE, KRISTY MARIE (ACNP)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:MARIE
Last Name:DEHNE
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:MARIE
Other - Last Name:NIEDBALSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3916 INDIAN RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:DEFIANCE
Mailing Address - State:MO
Mailing Address - Zip Code:63341-2025
Mailing Address - Country:US
Mailing Address - Phone:573-268-2120
Mailing Address - Fax:
Practice Address - Street 1:10010 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2106
Practice Address - Country:US
Practice Address - Phone:314-525-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019037259363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care