Individual
KRISTI A HAVERKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
13610 W MAPLE ST, WICHITA, KS 67235-8776
(316) 773-4500
(316) 773-4555
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003719265
MEDICARE
—
05
—
200962330B
—
KS
Enumeration date
10/23/2006
Last updated
08/17/2015
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