Theodore John Krzysik, MSN, APRN, FNP-BC
Individual provider Active NPI Family Nurse Practitioner · Conroe, TX
NPI 1225620032 · NPPES record last updated Jul 28, 2026
Key facts
- NPI
- 1225620032
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 4704317818 (MI)
- Practice address
- 1150 W Dallas St
Conroe, TX 77301-2208 - Phone
- (713) 955-4510
- NPI assigned
- Feb 3, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
1230 S I 75 Business Loop
Apt 126
Grayling, MI 49738-2025
1230 S I 75 Business Loop Apt
Suite 126
Grayling, MI 49738-2025
200 Oceangate
Suite 100
Long Beach, CA 90802-4316
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (5 enrollments) in MI, TX, CT, MS, IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221107000836 | MI | Practitioner - Nurse Practitioner | 0042687949 | Reassigns benefits to 1 organization |
| I20230814003685 | TX | Practitioner - Nurse Practitioner | 0042687949 | Reassigns benefits to 2 organizations |
| I20251016003495 | CT | Practitioner - Nurse Practitioner | 0042687949 | Reassigns benefits to 1 organization |
| I20251028001311 | MS | Practitioner - Nurse Practitioner | 0042687949 | Reassigns benefits to 1 organization |
| I20260317004075 | IL | Practitioner - Nurse Practitioner | 0042687949 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Master of Science - Nursing, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704317818 | MI | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Aj Marshall, LLC | Current |
Accepting new patients | |
| Molina Care Connections, LLC. | Nurse Practitioner | Current |
Accepting new patients |
| Aj Marshall Medical, PLLC | Current |
Accepting new patients |
Locations
200 Oceangate
Ste 100
Long Beach, CA 90802
Phone (562) 435-3666
175 Scott Swamp Rd
Farmington, CT 06032
Phone (860) 249-6752
2001 Butterfield Rd
Ste 750
Downers Grove, IL 60515
Phone (630) 381-1757
880 W Long Lake Rd
Troy, MI 48098
Phone (248) 227-6316
188 E Capitol St
Ste 700
Jackson, MS 39201
Phone (844) 809-8438
5605 N MacArthur Blvd
Ste 400
Irving, TX 75038
Phone (972) 536-7265
1660 Westridge Cir N
Irving, TX 75038
Phone (214) 467-9787
6910 FM 1488 Rd
Ste 3
Magnolia, TX 77354
Phone (281) 630-3836
Interoperability endpoints
- tkrzysik19510@direct-prd.molinahealthcare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 4704317818 | MI | Yes |
| Family Nurse Practitioner | 363LF0000X | 907853 | MS | |
| Family Nurse Practitioner | 363LF0000X | 209034864 | IL | |
| Registered Nurse | 163W00000X | 4704317818 | MI | |
| Nurse Practitioner | 363L00000X | 1123912 | TX |
Addresses
Primary practice location
1150 W Dallas St
Conroe, TX 77301-2208
Mailing address
1150 W Dallas St
Conroe, TX 77301-2208
Phone (713) 955-4510
Other practice location 1
3040 Bourn St
Lewiston, MI 49756-8134
Phone (989) 786-4877
Other providers in Conroe, TX
- Kroger Texas L P
- Kroger Texas L P
- Derek Gene Kroll
- Alaura Krukoski
- Tracy Krupp
- Mary Lael Kucera
- Tyler Lee Kucera
- James Nicholas Kuciemba
- Craig C Kuglen Jr.
- Mia Kuklin
All providers in Conroe, TX · Family Nurse Practitioner in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.