Provider Demographics
NPI:1780670174
Name:DEMUTH, KARLA MICHELLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:KARLA
Middle Name:MICHELLE
Last Name:DEMUTH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 SOUTHWIND DRIVE
Mailing Address - Street 2:
Mailing Address - City:JUNCTION CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66441-2750
Mailing Address - Country:US
Mailing Address - Phone:785-240-9200
Mailing Address - Fax:785-240-9238
Practice Address - Street 1:650 HUEBNER RD
Practice Address - Street 2:
Practice Address - City:FORT RILEY
Practice Address - State:KS
Practice Address - Zip Code:66442-4030
Practice Address - Country:US
Practice Address - Phone:785-240-9200
Practice Address - Fax:785-240-9238
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-44310363LW0102X
KS43310363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200641500BMedicaid
KS160220OtherBC/BS PROVIDER NUMBER