Active NPI
Kristen Nelson, DENTAL HYGENTIST
- Dental Hygienist
- New Madrid, MO
National Provider Identifier
1033237359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Hygienist
- License
- 2004016118
- Practice address
- 202B Main St
New Madrid, MO 63869-1911 - Phone
- (573) 748-5671
- Fax
- (573) 748-5317
- NPI assigned
- Mar 26, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Hygienist | 124Q00000X | 2004016118 | MO | Primary |
Addresses
Primary practice location
202B Main St
New Madrid, MO 63869-1911
Mailing address
202B Main St
P.O. Box 400
New Madrid, MO 63869-1911
Phone (573) 748-5671
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2004016118 | Other | MO | LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2004016118 | MO | MD | Dental Hygienist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southeast Missouri Health Network | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- New Madrid, MO
- NPI 1457570681
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1033237359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "202B MAIN ST",
"address_2": "P.O. BOX 400",
"city": "NEW MADRID",
"state": "MO",
"postal_code": "638691911",
"telephone_number": "573-748-5671",
"fax_number": "573-748-5317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202B MAIN ST",
"city": "NEW MADRID",
"state": "MO",
"postal_code": "638691911",
"telephone_number": "573-748-5671",
"fax_number": "573-748-5317"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "KRISTEN",
"credential": "DENTAL HYGENTIST",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "124Q00000X",
"taxonomy_group": "",
"desc": "Dental Hygienist",
"state": "MO",
"license": "2004016118",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE",
"identifier": "2004016118",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in New Madrid, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.