Michelle D Kretzschmar, RN, AE-C

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

127917 Issued in MO

Practice address

404 N Keene St
Suite 115
Columbia, MO 65201-6626

Phone

(573) 884-8190

Fax

(573) 884-3991

NPI assigned

Apr 12, 2017

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1491955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591574400000",
    "number": "1306370721",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 N KEENE ST",
            "address_2": "SUITE 115",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016626",
            "telephone_number": "573-884-8190",
            "fax_number": "573-884-3991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 N KEENE ST",
            "address_2": "SUITE 115",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016626",
            "telephone_number": "573-884-8190",
            "fax_number": "573-884-3991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRETZSCHMAR",
        "first_name": "MICHELLE",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "RN, AE-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-12",
        "last_updated": "2020-06-08",
        "certification_date": "2020-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "127917",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "35AE",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Registered Nurse in Columbia, MO
• Providers in Columbia, MO by specialty
• Registered Nurse in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2020; 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.