Basic Information
| Provider Information | |||||||||
| NPI: | 1316280373 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WHITNEY | ||||||||
| FirstName: | KRISTA | ||||||||
| MiddleName: | RENEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 346 MAINE ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441393 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858417297 | ||||||||
| FaxNumber: | 8556349302 | ||||||||
| Practice Location | |||||||||
| Address1: | 1803 W 6TH ST | ||||||||
| Address2: | |||||||||
| City: | LAWRENCE | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660441710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858417297 | ||||||||
| FaxNumber: | 7858560375 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 12/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208000000X | 04-42224 | KS | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.