Provider Demographics
NPI:1740285568
Name:CARRIKER, CRISTINE G (MD)
Entity type:Individual
Prefix:
First Name:CRISTINE
Middle Name:G
Last Name:CARRIKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 W 74TH ST
Mailing Address - Street 2:STE 325
Mailing Address - City:SHAWNEE MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66204-2207
Mailing Address - Country:US
Mailing Address - Phone:913-384-4990
Mailing Address - Fax:913-384-1310
Practice Address - Street 1:9301 W 74TH ST
Practice Address - Street 2:STE 325
Practice Address - City:SHAWNEE MISSION
Practice Address - State:KS
Practice Address - Zip Code:66204-2207
Practice Address - Country:US
Practice Address - Phone:913-384-4990
Practice Address - Fax:913-384-1310
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23514207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100133720AMedicaid
4723281Medicare ID - Type Unspecified
F34307Medicare UPIN