Healthcare Provider Details

I. General information

NPI: 1255361036
Provider Name (Legal Business Name): JENNIFER KRAUSE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3348 AMERICAN AVE
JEFFERSON CITY MO
65109-1079
US

IV. Provider business mailing address

3348 AMERICAN AVE
JEFFERSON CITY MO
65109-1079
US

V. Phone/Fax

Practice location:
  • Phone: 573-761-7210
  • Fax: 573-634-8802
Mailing address:
  • Phone: 573-761-7210
  • Fax: 573-634-8802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2003010048
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier208748400
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: