Provider Demographics
NPI:1326723545
Name:MATTSON, KRISTEN ELAINE (BSN, RN, SRNA)
Entity type:Individual
Prefix:MISS
First Name:KRISTEN
Middle Name:ELAINE
Last Name:MATTSON
Suffix:
Gender:F
Credentials:BSN, RN, SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:907 ROSE LN
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:IL
Mailing Address - Zip Code:62245-2039
Mailing Address - Country:US
Mailing Address - Phone:618-772-9585
Mailing Address - Fax:
Practice Address - Street 1:400 S WOODS MILL RD STE 140
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3427
Practice Address - Country:US
Practice Address - Phone:314-485-1101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024020240367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered