Provider Demographics
NPI:1891308094
Name:KRUSE, BRANDON PAUL (FNP-C; PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:PAUL
Last Name:KRUSE
Suffix:
Gender:M
Credentials:FNP-C; PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 W OVERLAND RD STE 3587
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-7618
Mailing Address - Country:US
Mailing Address - Phone:208-880-5890
Mailing Address - Fax:208-586-5055
Practice Address - Street 1:943 W OVERLAND RD STE 3587
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-7618
Practice Address - Country:US
Practice Address - Phone:208-880-5890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP6140750363LP0808X
OR202011497363LP0808X
UT13567379-4405363LP0808X
ID65554363LP2300X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care