Healthcare Provider Details

I. General information

NPI: 1164601373
Provider Name (Legal Business Name): KARL LANCE KROEN APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 E MARKET ST
LA CYGNE KS
66040-9102
US

IV. Provider business mailing address

2102 BAPTISTE DR
PAOLA KS
66071-1314
US

V. Phone/Fax

Practice location:
  • Phone: 913-757-4575
  • Fax: 913-757-3710
Mailing address:
  • Phone: 913-557-5678
  • Fax: 913-557-5681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number46099
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: