Provider Demographics
NPI:1528112729
Name:BLANCHARD, KRISTA (MPAS, PA-C)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:MPAS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 HOLMES RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1150
Mailing Address - Country:US
Mailing Address - Phone:816-276-7410
Mailing Address - Fax:816-276-7415
Practice Address - Street 1:6675 HOLMES RD
Practice Address - Street 2:SUITE 400
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1150
Practice Address - Country:US
Practice Address - Phone:816-276-7410
Practice Address - Fax:816-276-7415
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPA00096363AS0400X
MO2012006732363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08300063Medicaid
MS08300063Medicaid