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NPI Code Detail

MEDICARE: MRS. CORENE CROUSE RN FNP

MEDICARE: MRS. CORENE CROUSE RN FNP
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
1363LF0000XFamily Nurse Practitioner588761TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316926900
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CORENE CROUSE RN FNP
Provider Business Mailing Address
First Line : 2200 KELL BLVD
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76309-4401
Country : US
Telephone Number : 940-761-2833
Fax Number : 940-397-2289
Provider Business Practice Location Address
First Line : 2200 KELL BLVD
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76309-4401
Country : US
Telephone Number : 940-761-2833
Fax Number : 940-397-2289
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/11/2006
Last Update Date : 05/04/2010

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Directions to “ MRS. CORENE CROUSE RN FNP” Practice Location

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