MEDICARE: MR. THEODORE JOHN KRZYSIK MSN, APRN, FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	4704317818	MI
2	363L00000X	Nurse Practitioner	1123912	TX
3	363LF0000X	Family Nurse Practitioner	4704317818	MI

General Provider Information

NPI Number	:	1225620032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THEODORE JOHN KRZYSIK MSN, APRN, FNP-BC

Provider Business Mailing Address
First Line	:	1150 W DALLAS ST
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-2208
Country	:	US
Telephone Number	:	713-955-4510
Fax Number	:

Provider Business Practice Location Address
First Line	:	1150 W DALLAS ST
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77301-2208
Country	:	US
Telephone Number	:	713-955-4510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2021
Last Update Date	:	07/15/2025

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