Basic Information
| Provider Information | |||||||||
| NPI: | 1871657981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALD | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | JOY | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | RNC, WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10012 KENNERLY RD STE 405 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631282197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145436986 | ||||||||
| FaxNumber: | 3145436836 | ||||||||
| Practice Location | |||||||||
| Address1: | 10012 KENNERLY RD STE 405 | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631282197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145436986 | ||||||||
| FaxNumber: | 3145436836 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 12/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 147829 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.