Provider Demographics
NPI:1639102841
Name:WREN, KRISTINE KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:KAY
Last Name:WREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 590
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:SD
Mailing Address - Zip Code:57469-0590
Mailing Address - Country:US
Mailing Address - Phone:605-472-0510
Mailing Address - Fax:605-472-0331
Practice Address - Street 1:1010 W 1ST ST
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:SD
Practice Address - Zip Code:57469-1506
Practice Address - Country:US
Practice Address - Phone:605-472-0510
Practice Address - Fax:605-472-0331
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5850207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5612810Medicaid
SDG56374Medicare UPIN