Active NPI
Kendal Wagner Kruse, RD
- Registered Dietitian
- Nome, AK
National Provider Identifier
1184021156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 347
- Practice address
- 1000 Greg Kruschek Avenue
Nome, AK 99762 - Phone
- (907) 443-4589
- NPI assigned
- Nov 19, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 347 | AK | Primary |
Addresses
Primary practice location
1000 Greg Kruschek Avenue
Nome, AK 99762
Mailing address
PO Box 996
Nome, AK 99762
Phone (907) 443-3311
Other names 1
- Ms. Kendal Wagner Pike
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1416355200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1444780800000",
"number": "1184021156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 996",
"city": "NOME",
"state": "AK",
"postal_code": "99762",
"telephone_number": "907-443-3311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 GREG KRUSCHEK AVENUE",
"city": "NOME",
"state": "AK",
"postal_code": "99762",
"telephone_number": "907-443-4589"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUSE",
"first_name": "KENDAL",
"middle_name": "WAGNER",
"name_prefix": "Mrs.",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-11-19",
"last_updated": "2015-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "AK",
"license": "347",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KENDAL",
"last_name": "PIKE",
"middle_name": "WAGNER",
"prefix": "MS.",
"credential": "RD",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Nome, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.