Provider Demographics
NPI:1609378926
Name:SELF, KRISTYNA (LPN)
Entity Type:Individual
Prefix:
First Name:KRISTYNA
Middle Name:
Last Name:SELF
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:KRISTYNA
Other - Middle Name:
Other - Last Name:SWANCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5401 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2330
Mailing Address - Country:US
Mailing Address - Phone:785-273-2252
Mailing Address - Fax:785-273-7489
Practice Address - Street 1:2200 SW GAGE BLVD
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66622-1995
Practice Address - Country:US
Practice Address - Phone:785-350-3111
Practice Address - Fax:785-350-4701
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS23-52778-082164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse