Healthcare Provider Details

I. General information

NPI: 1538132899
Provider Name (Legal Business Name): CHARLES J KRYSL P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 01/19/2025
Certification Date: 01/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SAGE ST
GERING NE
69341-3227
US

IV. Provider business mailing address

1275 SAGE ST
GERING NE
69341-3227
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-2101
  • Fax:
Mailing address:
  • Phone: 308-436-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number840
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: