Healthcare Provider Details

I. General information

NPI: 1447724653
Provider Name (Legal Business Name): KRISTEN MICHELLE WASTLER CPNP-PC, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8340 MISSION RD STE 100
PRAIRIE VILLAGE KS
66206-1367
US

IV. Provider business mailing address

14621 GRANDVIEW ST
OVERLAND PARK KS
66221-2216
US

V. Phone/Fax

Practice location:
  • Phone: 913-642-2100
  • Fax: 913-642-2127
Mailing address:
  • Phone: 913-961-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number78540
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: