Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | LMLP 949 | KS |
NPI | 1003969171 |
---|---|
Provider Name | Ms. Krista Winegar |
First Address | Mission, KS 66202-3234 |
Second Address | Shawnee, KS 66203-3326 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 22/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100098080A | (05) | KS |
100098080C | SED WAIVER (01) | KS |