Provider Demographics
NPI:1063513521
Name:CRIDER, KAY L (MD)
Entity type:Individual
Prefix:DR
First Name:KAY
Middle Name:L
Last Name:CRIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 SW 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1696
Mailing Address - Country:US
Mailing Address - Phone:785-270-0047
Mailing Address - Fax:
Practice Address - Street 1:1516 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1696
Practice Address - Country:US
Practice Address - Phone:785-270-0047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18141207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100169230DMedicaid
KS30004414860001Medicaid
613210OtherFIRSTGUARD HEALTH PLAN
052070OtherBLUE CROSS BLUE SHIELD KS
613210OtherFIRSTGUARD HEALTH PLAN
C49928Medicare UPIN