Provider Demographics
NPI:1750440848
Name:HERRON, KRISTINE (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:
Last Name:HERRON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2790 CLAY EDWARDS DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:N KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64116-3276
Mailing Address - Country:US
Mailing Address - Phone:816-474-9353
Mailing Address - Fax:816-474-3627
Practice Address - Street 1:1295 E 151ST ST
Practice Address - Street 2:SUITE 7
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-3427
Practice Address - Country:US
Practice Address - Phone:913-381-0622
Practice Address - Fax:913-254-1120
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2010-08-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS22649207RN0300X
MOMDR4F10207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100114260BMedicaid
MO202661500Medicaid
KS100114260BMedicaid