Provider Demographics
NPI:1265771182
Name:CRIST, MARY BETH (APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:CRIST
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2845
Mailing Address - Country:US
Mailing Address - Phone:620-241-4477
Mailing Address - Fax:620-241-2716
Practice Address - Street 1:1101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2845
Practice Address - Country:US
Practice Address - Phone:620-241-4477
Practice Address - Fax:620-241-2716
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-74963-061364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist