Theodore John Krzysik, MSN, APRN, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704317818 Issued in MI

Practice address

1150 W Dallas St
Conroe, TX 77301-2208

Phone

(713) 955-4510

NPI assigned

Feb 3, 2021

Last updated

Oct 16, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, TX, CT, MS, IL5 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 5

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science - Nursing, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tkrzysik19510@direct-prd.molinahealthcare.com

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

• Aj Marshall Medical, PLLC

  dba Quality of Life Medical Center

  • Multi-Specialty Clinic/Center
  • Magnolia, TX
  • NPI 1669181707
  Medicare reassignment NPD
• Molina Care Connections, LLC.

  dba Molina CC

  • Nurse Practitioner
  • Long Beach, CA
  • NPI 1407243223

  CT, IL, MI, MS, TX

  Medicare reassignment NPD
• Aj Marshall, LLC

  dba Quality of Life Chiropractic

  • Clinic/Center
  • Magnolia, TX
  • NPI 1851674105
  NPD

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

{
    "created_epoch": "1612310400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1792108800000",
    "number": "1225620032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1150 W DALLAS ST",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773012208",
            "telephone_number": "713-955-4510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1150 W DALLAS ST",
            "city": "CONROE",
            "state": "TX",
            "postal_code": "773012208",
            "telephone_number": "713-955-4510"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3040 Bourn St",
            "address_purpose": "LOCATION",
            "city": "Lewiston",
            "state": "MI",
            "postal_code": "497568134",
            "country_code": "US",
            "telephone_number": "989-786-4877",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KRZYSIK",
        "first_name": "THEODORE",
        "middle_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "MSN, APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-03",
        "last_updated": "2026-10-16",
        "certification_date": "2026-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704317818",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1123912",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "907853",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209034864",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704317818",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "4052580",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kroger Texas L P (Kroger Pharmacy)
• Kroger Texas L P (Kroger Pharmacy)
• Derek Gene Kroll, DO
• Alaura Krukoski
• Tracy Krupp, RBT
• Mary Lael Kucera, PA
• Tyler Lee Kucera
• James Nicholas Kuciemba, PHD
• Craig C Kuglen Jr., M.D.
• Mia Kuklin

• Family Nurse Practitioner in Conroe, TX
• Providers in Conroe, TX by specialty
• Family Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.