Healthcare Provider Details

I. General information

NPI: 1194349258
Provider Name (Legal Business Name): JESSICA MARIE KRUCKENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 HOSPITAL DR
WEBSTER CITY IA
50595-6600
US

IV. Provider business mailing address

PO BOX 430
WEBSTER CITY IA
50595-0430
US

V. Phone/Fax

Practice location:
  • Phone: 515-832-7800
  • Fax: 515-832-9420
Mailing address:
  • Phone: 515-832-9400
  • Fax: 515-832-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA158572
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: