Basic Information
Provider Information
NPI: 1649699489
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DOFFING
FirstName: KRISTIN
MiddleName: F
NamePrefix: MS.
NameSuffix:  
Credential: APRN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 8035
Address2:  
City: WICHITA
State: KS
PostalCode: 672080035
CountryCode: US
TelephoneNumber: 3166899135
FaxNumber: 3166899667
Practice Location
Address1: 3311 E MURDOCK ST
Address2:  
City: WICHITA
State: KS
PostalCode: 672083054
CountryCode: US
TelephoneNumber: 3162686976
FaxNumber: 3166917897
Other Information
ProviderEnumerationDate: 04/09/2014
LastUpdateDate: 04/09/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X53-79252KSY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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