Provider Demographics
NPI:1740692888
Name:DEWITT, KRISTA RANAE (DO)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:RANAE
Last Name:DEWITT
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:RANAE
Other - Last Name:BACHAMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:830 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:KS
Mailing Address - Zip Code:67467-1608
Mailing Address - Country:US
Mailing Address - Phone:785-392-2144
Mailing Address - Fax:785-392-3231
Practice Address - Street 1:830 ELM ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:KS
Practice Address - Zip Code:67467-1608
Practice Address - Country:US
Practice Address - Phone:785-392-2144
Practice Address - Fax:785-392-3231
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0538092207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201141840BMedicaid