Provider Demographics
NPI:1477163194
Name:MOTTER, KRISTY R (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:R
Last Name:MOTTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:KRISTY
Other - Middle Name:R
Other - Last Name:WESCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 NE NORTHCREST RD
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-8839
Mailing Address - Country:US
Mailing Address - Phone:316-322-8717
Mailing Address - Fax:
Practice Address - Street 1:1737 SE US HIGHWAY 54
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-8264
Practice Address - Country:US
Practice Address - Phone:316-322-8717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-79327-122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily