MEDICARE: KAYLEN LEIGH KRUEGER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1073298618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLEN LEIGH KRUEGER

Provider Business Mailing Address
First Line	:	3836 SHORE CREST CT
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-9144
Country	:	US
Telephone Number	:	920-660-7614
Fax Number	:

Provider Business Practice Location Address
First Line	:	3836 SHORE CREST CT
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54311-9144
Country	:	US
Telephone Number	:	920-660-7614
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2023
Last Update Date	:	05/28/2025

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