Provider Demographics
NPI:1124488713
Name:KREGER, SUZANNE MARY (APRN)
Entity type:Individual
Prefix:MRS
First Name:SUZANNE
Middle Name:MARY
Last Name:KREGER
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-305-3070
Mailing Address - Fax:859-441-1348
Practice Address - Street 1:1400 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2570
Practice Address - Country:US
Practice Address - Phone:859-905-3070
Practice Address - Fax:859-441-1348
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71007969A363L00000X
KY3009763363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP01677801OtherRR MEDICARE
OH0170102Medicaid
KY7100420010Medicaid
OH0170102Medicaid