Provider Demographics
NPI:1922634039
Name:DE NAGEL, KRISTIAN ASHTIN (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:ASHTIN
Last Name:DE NAGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 SW MARYVILLE PL
Mailing Address - Street 2:
Mailing Address - City:LEE'S SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-1908
Mailing Address - Country:US
Mailing Address - Phone:321-304-1495
Mailing Address - Fax:
Practice Address - Street 1:600 NW MURRAY RD STE 201
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1227
Practice Address - Country:US
Practice Address - Phone:816-524-2626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-16196207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine