Healthcare Provider Details

I. General information

NPI: 1407711955
Provider Name (Legal Business Name): AUTUMN KRAGEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 DILLAWAY ST
MUSCATINE IA
52761-3011
US

IV. Provider business mailing address

106 DILLAWAY ST
MUSCATINE IA
52761-3011
US

V. Phone/Fax

Practice location:
  • Phone: 563-272-1181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number174443
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: