MEDICARE: JENNIE REBECCA KRULL PMHNP-BC

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	364SP0807X	Child & Adolescent Psychiatric/Mental Health Clinical Nurse Specialist	277000398	IL
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	277000398	IL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	377000394	IL
4	363LF0000X	Family Nurse Practitioner	277000398	IL

General Provider Information

NPI Number	:	1518322510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIE REBECCA KRULL PMHNP-BC

Provider Business Mailing Address
First Line	:	1050 COUNTRY CLUB RD UNIT 386
Second Line	:
City	:	WOODSTOCK
State	:	IL
Zip	:	60098-5585
Country	:	US
Telephone Number	:	815-501-5048
Fax Number	:

Provider Business Practice Location Address
First Line	:	555 S PERRYVILLE RD STE 130
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2527
Country	:	US
Telephone Number	:	815-995-2201
Fax Number	:	224-999-4002

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

Provider Enumeration Date	:	12/18/2015
Last Update Date	:	06/09/2026

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