Basic Information
| Provider Information | |||||||||
| NPI: | 1912232323 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCHRISTY | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GIRARD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667432000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6207245152 | ||||||||
| FaxNumber: | 6207246332 | ||||||||
| Practice Location | |||||||||
| Address1: | 302 N HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GIRARD | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667432000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6207245152 | ||||||||
| FaxNumber: | 6207246332 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2009 | ||||||||
| LastUpdateDate: | 03/06/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 53-74991-042 | KS | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 200628720A | 05 | KS | MEDICAID |