Provider Demographics
NPI:1245726710
Name:RIDER, KRISTEN (APRN, NP-C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RIDER
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 CARLTON DR
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-3807
Mailing Address - Country:US
Mailing Address - Phone:314-724-7879
Mailing Address - Fax:
Practice Address - Street 1:1400 US HIGHWAY 61 STE 210
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4141
Practice Address - Country:US
Practice Address - Phone:636-933-8880
Practice Address - Fax:636-933-8881
Is Sole Proprietor?:No
Enumeration Date:2018-07-07
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018023790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily