Healthcare Provider Details

I. General information

NPI: 1811329774
Provider Name (Legal Business Name): KRISTIN KAY POAGE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2013
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 SW GARFIELD AVE
TOPEKA KS
66606-1670
US

IV. Provider business mailing address

901 SW GARFIELD AVE
TOPEKA KS
66606-1670
US

V. Phone/Fax

Practice location:
  • Phone: 785-354-9591
  • Fax: 785-368-0497
Mailing address:
  • Phone: 785-354-9591
  • Fax: 785-368-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number13-94813
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number53-76049-021
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: