Provider Demographics
NPI:1134182421
Name:BOLTZ, KRISTIN M (ARNP)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:M
Last Name:BOLTZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 SW GAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66622-0001
Mailing Address - Country:US
Mailing Address - Phone:785-350-3111
Mailing Address - Fax:785-350-4701
Practice Address - Street 1:3313B THRASHER RD
Practice Address - Street 2:
Practice Address - City:WHITE CLOUD
Practice Address - State:KS
Practice Address - Zip Code:66094-4028
Practice Address - Country:US
Practice Address - Phone:785-585-3450
Practice Address - Fax:785-595-3493
Is Sole Proprietor?:No
Enumeration Date:2006-04-09
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-45497-031363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS161582OtherBLUE CROSS BLUE SHIELD
KS200306850BMedicaid
KS161582OtherBLUE CROSS BLUE SHIELD
KSQ21380Medicare UPIN