MEDICARE: KIMBERLEE KRUGER PERRAS MS, RN, FNP-C

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	363LF0000X	Family Nurse Practitioner	AP122753	TX
2	363LF0000X	Family Nurse Practitioner	5020009	NC

General Provider Information

NPI Number	:	1821337049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLEE KRUGER PERRAS MS, RN, FNP-C

Provider Business Mailing Address
First Line	:	PO BOX 604050
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-4050
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	855 SAM NEWELL RD.
Second Line	:	SUITE 204
City	:	MATTHEWS
State	:	NC
Zip	:	28105-7594
Country	:	US
Telephone Number	:	980-202-6643
Fax Number	:

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

Provider Enumeration Date	:	02/07/2013
Last Update Date	:	10/24/2024

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