Provider Demographics
NPI:1124736103
Name:VEGA, KRISTIN A (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:A
Last Name:VEGA
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:A
Other - Last Name:VEGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:509 BRECKENRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2269
Mailing Address - Country:US
Mailing Address - Phone:620-255-1256
Mailing Address - Fax:
Practice Address - Street 1:1701 E 23RD AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-9907
Practice Address - Country:US
Practice Address - Phone:620-200-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13101602363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care