Provider Demographics
NPI:1528773512
Name:CUNNINGHAM, KRISTIN R (PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:R
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1045 E 23RD ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5003
Mailing Address - Country:US
Mailing Address - Phone:785-393-6167
Mailing Address - Fax:
Practice Address - Street 1:1045 E 23RD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5003
Practice Address - Country:US
Practice Address - Phone:785-393-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-81805-0622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry