Healthcare Provider Details

I. General information

NPI: 1700846342
Provider Name (Legal Business Name): TERRY S KRANTZ RN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2006
Last Update Date: 06/01/2022
Certification Date: 05/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 N BUSINESS ROUTE 5
CAMDENTON MO
65020-6872
US

IV. Provider business mailing address

PO BOX 777
RICHLAND MO
65556-0777
US

V. Phone/Fax

Practice location:
  • Phone: 877-406-2662
  • Fax:
Mailing address:
  • Phone: 877-406-2662
  • Fax: 573-636-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number080762
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: