Provider Demographics
NPI:1336399971
Name:BARTON, KRISTINE ELAINE (RN)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ELAINE
Last Name:BARTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:616 GREEN STREET RD
Mailing Address - Street 2:
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-2128
Mailing Address - Country:US
Mailing Address - Phone:618-340-0556
Mailing Address - Fax:
Practice Address - Street 1:616 GREEN STREET RD
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-2128
Practice Address - Country:US
Practice Address - Phone:618-340-0556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2008-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.365478163W00000X
CA698086163W00000X
MO2006006149163WX0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0002XNursing Service ProvidersRegistered NurseObstetric, High-Risk
No163W00000XNursing Service ProvidersRegistered Nurse