Provider Demographics
NPI:1164296091
Name:KRISHA, WYNTER (CPM)
Entity type:Individual
Prefix:
First Name:WYNTER
Middle Name:
Last Name:KRISHA
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 . S N. MAIN ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301
Mailing Address - Country:US
Mailing Address - Phone:916-300-2750
Mailing Address - Fax:
Practice Address - Street 1:108 . S N. MAIN ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301
Practice Address - Country:US
Practice Address - Phone:916-300-2750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-10
Last Update Date:2024-09-12
Deactivation Date:2024-05-24
Deactivation Code:
Reactivation Date:2024-07-25
Provider Licenses
StateLicense IDTaxonomies
175M00000X
CPM24050470176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwife
No175M00000XOther Service ProvidersMidwife, LayGroup - Single Specialty