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General NPI Number Information
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NPI Number | 1225620032
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Entity Type | Individual
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Provider Name | THEODORE JOHN KRZYSIK MSN, APRN, FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 02/03/2021
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Last Update Date | 07/28/2026
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Provider Practice Location Address
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Address Line | 1150 W DALLAS ST
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City | CONROE
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State | TX
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Zip | 77301-2208
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Country | US
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Telephone | 713-955-4510
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 W DALLAS ST
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City | CONROE
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State | TX
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Zip | 77301-2208
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Country | US
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Telephone | 713-955-4510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704317818
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 907853
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209034864
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704317818
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1123912
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License Number State | TX
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