Healthcare Provider Details

I. General information

NPI: 1891211223
Provider Name (Legal Business Name): NATHAN ELLIOT KRAGH APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2017
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S COULTER ST
AMARILLO TX
79106-1786
US

IV. Provider business mailing address

1400 WALLACE BLVD
AMARILLO TX
79106-1708
US

V. Phone/Fax

Practice location:
  • Phone: 806-414-9558
  • Fax: 806-354-5693
Mailing address:
  • Phone: 806-414-9558
  • Fax: 806-354-5693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP134639
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: