Provider Demographics
NPI:1659453546
Name:MALL, KRISTINE D (RN BC ANP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:D
Last Name:MALL
Suffix:
Gender:F
Credentials:RN BC ANP
Other - Prefix:
Other - First Name:KRISTINE
Other - Middle Name:
Other - Last Name:BOENKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2409 SW CURRENT LN
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4099
Mailing Address - Country:US
Mailing Address - Phone:816-524-5432
Mailing Address - Fax:
Practice Address - Street 1:2330 E MEYER BLVD STE 101
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1140
Practice Address - Country:US
Practice Address - Phone:816-276-9800
Practice Address - Fax:816-276-9201
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO127507363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner