Provider Demographics
NPI:1629116694
Name:WADE, KRISTA LEE
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LEE
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12520 S COTTONWOOD DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1196
Mailing Address - Country:US
Mailing Address - Phone:913-393-3386
Mailing Address - Fax:
Practice Address - Street 1:12520 S COTTONWOOD DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1196
Practice Address - Country:US
Practice Address - Phone:913-393-3386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities