Provider Demographics
NPI:1316926900
Name:CROUSE, CORENE (RN FNP)
Entity type:Individual
Prefix:MRS
First Name:CORENE
Middle Name:
Last Name:CROUSE
Suffix:
Gender:F
Credentials:RN FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 KELL BLVD
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76309-4401
Mailing Address - Country:US
Mailing Address - Phone:940-761-2833
Mailing Address - Fax:940-397-2289
Practice Address - Street 1:2200 KELL BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76309-4401
Practice Address - Country:US
Practice Address - Phone:940-761-2833
Practice Address - Fax:940-397-2289
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX588761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1984759-01Medicaid
TX1984759-01Medicaid