Provider Demographics
NPI:1013267319
Name:PEREZ, KRISTIN DEANN (CNM)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:DEANN
Last Name:PEREZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:DEANN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:830 SW LANE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-2487
Mailing Address - Country:US
Mailing Address - Phone:785-354-5952
Mailing Address - Fax:
Practice Address - Street 1:830 SW LANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2487
Practice Address - Country:US
Practice Address - Phone:785-354-5952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75745367A00000X
KS75745176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002197OtherMEDICARE PTAN
KS200971830AMedicaid