Provider Demographics
NPI:1932690567
Name:WALL, KRISTIN LEIGH (WHNP)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LEIGH
Last Name:WALL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LEIGH
Other - Last Name:HERSCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, WHNP-BC
Mailing Address - Street 1:10004 KENNERLY RD STE 230A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2181
Mailing Address - Country:US
Mailing Address - Phone:314-525-4220
Mailing Address - Fax:
Practice Address - Street 1:10004 KENNERLY RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2141
Practice Address - Country:US
Practice Address - Phone:314-525-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014007727163WX0003X
MO2018030311363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient