Provider Demographics
NPI:1699712463
Name:KRUG, LINDA K (PA-C)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:K
Last Name:KRUG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2759
Mailing Address - Country:US
Mailing Address - Phone:785-483-3811
Mailing Address - Fax:785-483-2727
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2759
Practice Address - Country:US
Practice Address - Phone:785-483-3811
Practice Address - Fax:785-483-2727
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00329363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100346450BMedicaid
KS042078OtherBCBS
KS042078Medicare ID - Type Unspecified