Kerry A Kroeker, APRN BC FNP GNP
Individual provider Active NPI Specialist · Fayette, MO
NPI 1679697346 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1679697346
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- 140382 (MO)
- Practice address
- 600 W Morrison St
Suite 5
Fayette, MO 65248-1075 - Phone
- (660) 248-2900
- Fax
- (660) 248-1544
- NPI assigned
- Mar 19, 2007
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 140382 | MO | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 140382 | MO | Yes |
Addresses
Primary practice location
600 W Morrison St
Suite 5
Fayette, MO 65248-1075
Mailing address
600 W Morrison St
Suite 5
Fayette, MO 65248-1075
Phone (660) 248-2900
Other providers in Fayette, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.