MEDICARE: COURTNEY G KRUSE R.D., L.D.

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	133V00000X	Registered Dietitian	1372	KS

General Provider Information

NPI Number	:	1780925545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY G KRUSE R.D., L.D.

Provider Business Mailing Address
First Line	:	12115 S MONROE ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-5673
Country	:	US
Telephone Number	:	913-515-8802
Fax Number	:

Provider Business Practice Location Address
First Line	:	12115 S MONROE ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66061-5673
Country	:	US
Telephone Number	:	913-515-8802
Fax Number	:

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

Provider Enumeration Date	:	03/04/2013
Last Update Date	:	04/14/2026

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