Kristine M Wake, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

12807093-1205 Issued in UT

Practice address

750 Round Valley Dr Ste 102
Park City, UT 84060-7549

Phone

(435) 655-0926

Fax

(435) 649-3748

NPI assigned

Aug 24, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Wasatch Pediatrics, Inc

  • Pediatrics Physician
  • West Jordan, UT
  • NPI 1124102595
  NPD (past)
• Children'S Health System

  • Pediatric Nurse Practitioner
  • New Berlin, WI
  • NPI 1982526737
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1932216975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE # MS 958",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-7615",
            "fax_number": "414-266-6238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 ROUND VALLEY DR STE 102",
            "city": "PARK CITY",
            "state": "UT",
            "postal_code": "840607549",
            "telephone_number": "435-655-0926",
            "fax_number": "435-649-3748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAKE",
        "first_name": "KRISTINE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-24",
        "last_updated": "2023-03-07",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "WI",
            "license": "41975",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "UT",
            "license": "12807093-1205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1932216975",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Claudia E. Vogl, L.C.S.W.
• Nicholas Von Der Ahe, MD
• Ryan Voss, DPT
• Wade Peers DDS PC
• Carly A Wagner
• Walgreen Co
• Cody Allen Walker, PHARMD
• Walmart Inc.
• Samuel Grey Walter
• Alison Warcup

• Pediatrics Physician in Park City, UT
• Providers in Park City, UT by specialty
• Pediatrics Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.