Nicole R. Kruger, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2010042353 Issued in MO

Practice address

249 Clarkson Rd
Suite 102
Ellisville, MO 63011-2219

Phone

(515) 557-0560

NPI assigned

Sep 20, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mind and Spirit Counseling Center

  • Mental Health Counselor
  • Urbandale, IA
  • NPI 1578574786
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300838400000",
    "number": "1154428076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "249 CLARKSON RD",
            "address_2": "SUITE 102",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112219",
            "telephone_number": "515-557-0560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "249 CLARKSON RD",
            "address_2": "SUITE 102",
            "city": "ELLISVILLE",
            "state": "MO",
            "postal_code": "630112219",
            "telephone_number": "515-557-0560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUGER",
        "first_name": "NICOLE",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2011-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MO",
            "license": "2010042353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLMARK BLUE CROSS",
            "identifier": "02934",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "7522737",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRIWEST",
            "identifier": "42105384450265A022",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Markus Koeppel, D.O.
• Amelia Kohnen
• David M Komor, RPH
• Ellen Marie Komp
• Jason David Kreuzman, OTR/L
• Jill Krussel, OTR
• Karen S. Kubb, PT
• L & R Behavioral Health Services, LLC
• L & R Behavioral Health Services, LLC
• Joseph Herbert Laffler, DDS

• Clinical Psychologist in Ellisville, MO
• Providers in Ellisville, MO by specialty
• Clinical Psychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.