Provider Demographics
NPI:1679919005
Name:MCCORMICK, KRISTINA WILSON
Entity Type:Individual
Prefix:DR
First Name:KRISTINA
Middle Name:WILSON
Last Name:MCCORMICK
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 1:6420 CLAYTON RD
Mailing Address - Street 2:DEPT. OF OB/GYN
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1811
Mailing Address - Country:US
Mailing Address - Phone:314-768-8800
Mailing Address - Fax:314-645-8771
Practice Address - Street 1:6420 CLAYTON RD
Practice Address - Street 2:DEPT. OF OB/GYN
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1811
Practice Address - Country:US
Practice Address - Phone:314-768-8800
Practice Address - Fax:314-645-8771
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2015-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013021769207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology