Provider Demographics
NPI:1679011977
Name:LENAND, KRISTEN
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:LENAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6116 W STATE HIGHWAY 162
Mailing Address - Street 2:
Mailing Address - City:GIDEON
Mailing Address - State:MO
Mailing Address - Zip Code:63848-9177
Mailing Address - Country:US
Mailing Address - Phone:573-379-6906
Mailing Address - Fax:
Practice Address - Street 1:405 PAGE STREET
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:MO
Practice Address - Zip Code:63837
Practice Address - Country:US
Practice Address - Phone:573-379-6906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO161010490018172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker