Provider Demographics
NPI:1861474587
Name:TERRILL, KRISTEN A (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:TERRILL
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 23340
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63156-3340
Mailing Address - Country:US
Mailing Address - Phone:314-965-5437
Mailing Address - Fax:314-965-5439
Practice Address - Street 1:9930 WATSON RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1827
Practice Address - Country:US
Practice Address - Phone:314-965-5437
Practice Address - Fax:314-965-5439
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005028570208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO269390OtherGHP
MO7949752OtherAETNA
MO60927V3431OtherHEALTHCARE USA
MO206159OtherBCBS
MO1202181OtherUHC
MO431383893TEROtherMERCY
MO737944OtherHEALTHLINK