Basic Information
| Provider Information | |||||||||
| NPI: | 1669899837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GROW | ||||||||
| FirstName: | KRISTA | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BERGMAN | ||||||||
| OtherFirstName: | KRISTA | ||||||||
| OtherMiddleName: | L | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1500 SW 10TH AVE. | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041353 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853546000 | ||||||||
| FaxNumber: | 7853545004 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 SW 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666041301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7853546000 | ||||||||
| FaxNumber: | 7853545004 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 04-39769 | KS | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.