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General NPI Number Information
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NPI Number | 1891308094
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Entity Type | Individual
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Provider Name | BRANDON PAUL KRUSE FNP-C; PMHNP-BC
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Gender | Male
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 05/17/2025
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Provider Practice Location Address
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Address Line | 943 W OVERLAND RD STE 3587
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City | MERIDIAN
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State | ID
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Zip | 83642-7618
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Country | US
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Telephone | 208-880-5890
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Fax |
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Provider Business Mailing Address
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Address Line | 943 W OVERLAND RD STE 3587
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City | MERIDIAN
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State | ID
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Zip | 83642-7618
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Country | US
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Telephone | 208-880-5890
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Fax | 208-586-5055
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP6140750
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 202011497
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 13567379-4405
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 65554
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License Number State | ID
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 65554
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License Number State | ID
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