Provider Demographics
NPI:1669899837
Name:GROW, KRISTA L (MD)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:GROW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:L
Other - Last Name:BERGMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1500 SW 10TH AVE.
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1353
Mailing Address - Country:US
Mailing Address - Phone:785-354-6000
Mailing Address - Fax:785-354-5004
Practice Address - Street 1:1500 SW 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1301
Practice Address - Country:US
Practice Address - Phone:785-354-6000
Practice Address - Fax:785-354-5004
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01085553A207P00000X
KS04-39769207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine