Provider Demographics
NPI:1629005327
Name:STOVERN, KRISTIN (DNP, CNM, FACNM)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:
Last Name:STOVERN
Suffix:
Gender:F
Credentials:DNP, CNM, FACNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MERCY WAY STE 560
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4524
Mailing Address - Country:US
Mailing Address - Phone:417-624-2621
Mailing Address - Fax:417-624-4652
Practice Address - Street 1:100 MERCY WAY STE 560
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4524
Practice Address - Country:US
Practice Address - Phone:417-624-2621
Practice Address - Fax:417-624-4652
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO146706176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01997Medicare UPIN