Healthcare Provider Details

I. General information

NPI: 1679697346
Provider Name (Legal Business Name): KERRY A KROEKER APRN BC FNP GNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W MORRISON ST SUITE 5
FAYETTE MO
65248-1075
US

IV. Provider business mailing address

600 W MORRISON ST SUITE 5
FAYETTE MO
65248-1075
US

V. Phone/Fax

Practice location:
  • Phone: 660-248-2900
  • Fax: 660-248-1544
Mailing address:
  • Phone: 660-248-2900
  • Fax: 660-248-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number140382
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: