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General NPI Number Information
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NPI Number | 1619543741
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Entity Type | Individual
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Provider Name | JENNIFER D KREJCAREK
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Gender | Female
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Dates
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Enumeration Date | 05/30/2021
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Last Update Date | 05/30/2021
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Provider Practice Location Address
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Address Line | 5116 N CROATAN HWY
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City | KITTY HAWK
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State | NC
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Zip | 27949-3988
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Country | US
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Telephone | 252-335-2293
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Fax |
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Provider Business Mailing Address
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Address Line | 903 SUFFOLK ST
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City | KILL DEVIL HILLS
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State | NC
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Zip | 27948-8211
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Country | US
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Telephone | 757-404-7444
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5014485
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License Number State | NC
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