Carrie Ann Kralicek, PMHNP-BC

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

201401811NP-PP Issued in OR

Practice address

153 N Broadway
Coos Bay, OR 97420-1633

Phone

(541) 808-9599

Fax

(541) 808-9559

NPI assigned

Jun 10, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jul 1, 2022 through Jul 1, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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.

• Optic One Eye Care Centers of Spokane PC

  dba Optic One Eye Care

  • Optometrist
  • Spokane, WA
  • NPI 1801948013
  NPD (past)

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

{
    "created_epoch": "1370822400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1470700800000",
    "number": "1164860383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "153 N BROADWAY",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974201633",
            "telephone_number": "541-808-9599",
            "fax_number": "541-808-9559"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "153 N BROADWAY",
            "city": "COOS BAY",
            "state": "OR",
            "postal_code": "974201633",
            "telephone_number": "541-808-9599",
            "fax_number": "541-808-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRALICEK",
        "first_name": "CARRIE",
        "middle_name": "ANN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-10",
        "last_updated": "2016-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WA",
            "license": "IP60386649",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "OR",
            "license": "201401811NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lowell Edmund Kobrin, PHD MD
• Rachel Kolbinsky, MD
• James Robert Kornbau, M.S.
• James Paul Kowall, M.D.
• Stephen P. Krajcir, MSW, LCSW
• Teri Sue Kruzner, RN
• Leo Kusuda, M.D.
• Kimberly Ann Kyllo-Martin, FNP-PP
• Benjamin A La Mar, LCSW
• Jerry William Lacy

• Psychiatric/Mental Health Nurse Practitioner in Coos Bay, OR
• Providers in Coos Bay, OR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.