Provider Demographics
NPI:1982770608
Name:GRIFFIN, KRISTIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:L
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2580
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65801-2580
Mailing Address - Country:US
Mailing Address - Phone:417-829-4620
Mailing Address - Fax:417-829-4316
Practice Address - Street 1:940 W MOUNT VERNON ST
Practice Address - Street 2:SUITE 210
Practice Address - City:NIXA
Practice Address - State:MO
Practice Address - Zip Code:65714-9609
Practice Address - Country:US
Practice Address - Phone:417-724-5300
Practice Address - Fax:417-724-5303
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2010-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2005012168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR184494001Medicaid
MO207174400Medicaid
AR184494001Medicaid
MOH19387Medicare UPIN