Provider Demographics
NPI:1104160365
Name:KRUEGER, CRYSTAL (FNP)
Entity type:Individual
Prefix:MRS
First Name:CRYSTAL
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12330 METCALF AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1324
Mailing Address - Country:US
Mailing Address - Phone:913-317-7990
Mailing Address - Fax:913-317-7018
Practice Address - Street 1:12330 METCALF AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1324
Practice Address - Country:US
Practice Address - Phone:913-317-7990
Practice Address - Fax:913-317-7018
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS75852363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
G93000039Medicare PIN