Provider Demographics
NPI:1972529709
Name:ANTONY, KRISTIN (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:ANTONY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 ARMSTRONG AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101-2701
Mailing Address - Country:US
Mailing Address - Phone:913-233-3300
Mailing Address - Fax:
Practice Address - Street 1:600 S COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-2626
Practice Address - Country:US
Practice Address - Phone:660-543-4777
Practice Address - Fax:660-543-8222
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018028451363LP0808X
KS74647363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100098080AMedicaid
KS100337780CMedicaid
KS100098080CMedicaid
KS100098080CMedicaid