Provider Demographics
NPI:1891576476
Name:KNOWLES, KRISTEN GRACE MACARAEG
Entity Type:Individual
Prefix:
First Name:KRISTEN GRACE
Middle Name:MACARAEG
Last Name:KNOWLES
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 1:958 N LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-1844
Mailing Address - Country:US
Mailing Address - Phone:316-250-1669
Mailing Address - Fax:
Practice Address - Street 1:958 N LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-1844
Practice Address - Country:US
Practice Address - Phone:316-250-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS117361163WC0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine