Individual
KRISTY PROVENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, BSN, WCC
Contact information
Practice address
15845 GARDNER WEST RD, GARDNER, KS 66030-9507
(913) 207-5089
(913) 273-1094
Mailing address
15845 GARDNER WEST RD, GARDNER, KS 66030-9507
(913) 207-5089
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
116337
KS
363LF0000X
Family Nurse Practitioner
Primary
53-82741-021
KS
Other
Enumeration date
12/15/2023
Last updated
04/10/2025
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