1528112729 NPI number — KRISTA BLANCHARD MPAS, PA-C

Table of content: KRISTA BLANCHARD MPAS, PA-C (NPI 1528112729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528112729 NPI number — KRISTA BLANCHARD MPAS, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLANCHARD
Provider First Name:
KRISTA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MPAS, PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528112729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6675 HOLMES RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
KANSAS CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64131-1150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-276-7410
Provider Business Mailing Address Fax Number:
816-276-7415

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6675 HOLMES RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64131-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-276-7410
Provider Business Practice Location Address Fax Number:
816-276-7415
Provider Enumeration Date:
01/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X , with the licence number:  PA00096 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X , with the licence number: 2012006732 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 08300063 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".