Healthcare Provider Details

I. General information

NPI: 1275123903
Provider Name (Legal Business Name): KRISTI JO KRUEGER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

226 GARDEN BROOK DR
MADISON AL
35758-7886
US

IV. Provider business mailing address

226 GARDEN BROOK DR
MADISON AL
35758-7886
US

V. Phone/Fax

Practice location:
  • Phone: 719-351-9175
  • Fax:
Mailing address:
  • Phone: 719-351-9175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-163577
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-163577
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number1-163577
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-163577
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1-163577
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number1-163577
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: