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NPI Code Detail

MEDICARE: KRISTA RANAE DEWITT D.O.

MEDICARE: KRISTA RANAE DEWITT D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician0538092KS

General Provider Information

NPI Number : 1740692888
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTA RANAE DEWITT D.O.
Provider Business Mailing Address
First Line : 830 ELM ST
Second Line :
City : MINNEAPOLIS
State : KS
Zip : 67467-1608
Country : US
Telephone Number : 785-392-2144
Fax Number : 785-392-3231
Provider Business Practice Location Address
First Line : 830 ELM ST
Second Line :
City : MINNEAPOLIS
State : KS
Zip : 67467-1608
Country : US
Telephone Number : 785-392-2144
Fax Number : 785-392-3231
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2014
Last Update Date : 03/05/2025

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