Provider Demographics
NPI:1184162414
Name:ARNOLD, KIRSTIN (LAT, ATC)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:
Last Name:ARNOLD
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900C WINCHESTER DR APT 7
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-2183
Mailing Address - Country:US
Mailing Address - Phone:816-507-7634
Mailing Address - Fax:
Practice Address - Street 1:3222 W 16TH ST
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2105
Practice Address - Country:US
Practice Address - Phone:660-837-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2019-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MO20180244342081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program