Provider Demographics
NPI:1174132625
Name:CROSSLAND, KATIE NICOLE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:NICOLE
Last Name:CROSSLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:OSBORNE
Mailing Address - State:KS
Mailing Address - Zip Code:67473-2010
Mailing Address - Country:US
Mailing Address - Phone:785-673-3342
Mailing Address - Fax:
Practice Address - Street 1:237 W HARRISON ST
Practice Address - Street 2:
Practice Address - City:OSBORNE
Practice Address - State:KS
Practice Address - Zip Code:67473-1500
Practice Address - Country:US
Practice Address - Phone:785-673-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS113956163WE0003X
KS53-81261-041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency