Provider Demographics
NPI:1386648871
Name:DUTTON SPEER, KRISTI S (MSN, APRN, BC)
Entity type:Individual
Prefix:MS
First Name:KRISTI
Middle Name:S
Last Name:DUTTON SPEER
Suffix:
Gender:F
Credentials:MSN, APRN, BC
Other - Prefix:MS
Other - First Name:KRISTI
Other - Middle Name:S
Other - Last Name:DUTTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, ARNP, BC
Mailing Address - Street 1:6612 E MARJORIE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1426
Mailing Address - Country:US
Mailing Address - Phone:316-641-9294
Mailing Address - Fax:
Practice Address - Street 1:9333 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2927
Practice Address - Country:US
Practice Address - Phone:316-634-4700
Practice Address - Fax:316-634-4770
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS74825363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100644470BMedicaid
KS161358Medicare ID - Type Unspecified
KS100644470BMedicaid