Provider Demographics
NPI:1932428943
Name:SKINNER, KRISTI DAWN (MSN, APRN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:DAWN
Last Name:SKINNER
Suffix:
Gender:F
Credentials:MSN, APRN, ACNS-BC
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:DAWN
Other - Last Name:ROARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63702-1329
Mailing Address - Country:US
Mailing Address - Phone:573-339-1957
Mailing Address - Fax:573-339-9709
Practice Address - Street 1:1723 BROADWAY ST STE 410
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-4556
Practice Address - Country:US
Practice Address - Phone:573-339-1957
Practice Address - Fax:573-339-9709
Is Sole Proprietor?:No
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010016453364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health