Provider Demographics
NPI:1598080426
Name:GILLENWATER, KRISTIN STONEBRAKER (DO)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:STONEBRAKER
Last Name:GILLENWATER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:4000 CAMBRIDGE 6040 DELP MS 1020
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66160-0001
Mailing Address - Country:US
Mailing Address - Phone:913-588-5165
Mailing Address - Fax:913-588-3877
Practice Address - Street 1:4000 CAMBRIDGE 6040 DELP MS 1020
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-5165
Practice Address - Fax:913-588-3877
Is Sole Proprietor?:No
Enumeration Date:2010-04-03
Last Update Date:2018-07-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2013020396207R00000X
KS05-41063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine