Provider Demographics
NPI:1235762014
Name:CHERNOFF, KRISTA ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:ANN
Last Name:CHERNOFF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3220 W 82ND TER
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1118
Mailing Address - Country:US
Mailing Address - Phone:913-961-7365
Mailing Address - Fax:
Practice Address - Street 1:2200 W 47TH PL UNIT 101
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-1865
Practice Address - Country:US
Practice Address - Phone:913-800-8073
Practice Address - Fax:913-273-5721
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-19
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79133-042363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner