Kristina Louise Provorse

NPI #1255090155 in Kennett, Missouri

Provider Information

NPI Number: 1255090155
Entity Type: Individual
Name: Kristina Louise Provorse
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Behavior Technician
Enumeration Date: Dec 8, 2021
Last Updated: Dec 8, 2021

Practice Location

Address: 1109 JONES ST
City: Kennett
State: Missouri
ZIP Code: 63857-3824
Phone: (573) 888-5925

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Behavior Technician	106S00000X	Primary

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