Provider Demographics
NPI:1871180265
Name:BRIMBERRY, KRISTERPHER DEAN (PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTERPHER
Middle Name:DEAN
Last Name:BRIMBERRY
Suffix:
Gender:M
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:PO BOX 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:225 PHYSICIANS PARK STE 400
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3923
Practice Address - Country:US
Practice Address - Phone:573-772-7722
Practice Address - Fax:573-778-7282
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020127887363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2015036359OtherREGISTERED NURSE
MO2020127887OtherPSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER