Provider Demographics
NPI:1396441572
Name:KRUGER, LISA KAYE (PMHNP-BC, MSN, RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAYE
Last Name:KRUGER
Suffix:
Gender:F
Credentials:PMHNP-BC, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S PETERS RD STE 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-5229
Mailing Address - Country:US
Mailing Address - Phone:865-789-2290
Mailing Address - Fax:
Practice Address - Street 1:214 S PETERS RD STE 101
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-5229
Practice Address - Country:US
Practice Address - Phone:865-789-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN33256363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health