Mallory Ann Krueger, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

74289-21 Issued in WI

Practice address

6900 Alden Dr
Fe Warren Afb, WY 82005-2945

Phone

(307) 773-3461

NPI assigned

Apr 29, 2019

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

Medicare fee-for-service enrollment

Enrolled in NV

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1346804952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6900 ALDEN DR",
            "city": "FE WARREN AFB",
            "state": "WY",
            "postal_code": "820052945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6900 ALDEN DR",
            "city": "FE WARREN AFB",
            "state": "WY",
            "postal_code": "820052945",
            "telephone_number": "307-773-3461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUEGER",
        "first_name": "MALLORY",
        "middle_name": "ANN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-29",
        "last_updated": "2023-08-02",
        "certification_date": "2023-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "74289-21",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tann Samuel Jones, DDS
• Jonah Phillip Justice
• Jodi Lynn Keithley, RD, LD
• Brooke R Kibel, OD, FAAO
• Vance Knauer, DMD
• Hallie Denise Landreth, PH D
• Haley Isham Lawson, PA-C
• Lisa Sung Eun Lee, PHARM D
• Shannon Freshwater Long, PA-C
• Brian Gregory Lusk, DDS

• Family Medicine Physician in Fe Warren Afb, WY
• Providers in Fe Warren Afb, WY by specialty
• Family Medicine Physician in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.