Provider Demographics
NPI:1013002542
Name:ENGLERT, CARRIE L (ANP-C, AOCNP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:L
Last Name:ENGLERT
Suffix:
Gender:F
Credentials:ANP-C, AOCNP
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:L
Other - Last Name:KRUMHOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 INDIAN CREEK PKWY
Mailing Address - Street 2:BLDG. 9, STE. 300
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2002
Mailing Address - Country:US
Mailing Address - Phone:913-574-2800
Mailing Address - Fax:913-574-2336
Practice Address - Street 1:12200 W 110TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-4045
Practice Address - Country:US
Practice Address - Phone:913-574-2650
Practice Address - Fax:913-574-2769
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS45768363LA2200X
MO2004012535363LA2200X, 163W00000X
KS14-90398-041163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1013002542Medicaid
KS200347050CMedicaid
KSK40000050Medicare PIN
KSP01033043Medicare PIN
KS200347050CMedicaid