Healthcare Provider Details

I. General information

NPI: 1740692888
Provider Name (Legal Business Name): KRISTA RANAE DEWITT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTA RANAE BACHAMP D.O.

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 ELM ST
MINNEAPOLIS KS
67467-1608
US

IV. Provider business mailing address

830 ELM ST
MINNEAPOLIS KS
67467-1608
US

V. Phone/Fax

Practice location:
  • Phone: 785-392-2144
  • Fax: 785-392-3231
Mailing address:
  • Phone: 785-392-2144
  • Fax: 785-392-3231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0538092
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: