Provider Demographics
NPI:1831143411
Name:KLINT, KRISTOPHER MICHAEL (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:MICHAEL
Last Name:KLINT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11184 ANTIOCH RD
Mailing Address - Street 2:#327
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2420
Mailing Address - Country:US
Mailing Address - Phone:816-820-6448
Mailing Address - Fax:
Practice Address - Street 1:2100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:GRANITE CITY
Practice Address - State:IL
Practice Address - Zip Code:62040-4701
Practice Address - Country:US
Practice Address - Phone:618-798-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001018435367500000X
KS5546367500000X
TX715179367500000X
PARN566387367500000X
WAAP30007050367500000X
OH322817367500000X
ME51848367500000X
IL367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered