Healthcare Provider Details

I. General information

NPI: 1912371717
Provider Name (Legal Business Name): THOMAS KROCHALIS CRNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2015
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 TAVERN RD
MARTINSBURG WV
25401-2890
US

IV. Provider business mailing address

PO BOX 1146
MARTINSBURG WV
25402-1146
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-4999
  • Fax:
Mailing address:
  • Phone: 304-263-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP015393
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN002114
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP015393
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberSP022998
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number120556
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: