Healthcare Provider Details

I. General information

NPI: 1861204554
Provider Name (Legal Business Name): CHRISTA JANELLE TITUS DNP, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2025
Last Update Date: 01/21/2025
Certification Date: 01/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 308
PRATT KS
67124-0308
US

IV. Provider business mailing address

PO BOX 308
PRATT KS
67124-0308
US

V. Phone/Fax

Practice location:
  • Phone: 620-672-7422
  • Fax: 855-884-8184
Mailing address:
  • Phone: 620-672-7422
  • Fax: 855-884-8184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number13-152417-112
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-83968-112
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: