Provider Demographics
NPI:1225620032
Name:KRZYSIK, THEODORE JOHN (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:JOHN
Last Name:KRZYSIK
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 W DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77301-2208
Mailing Address - Country:US
Mailing Address - Phone:713-955-4510
Mailing Address - Fax:
Practice Address - Street 1:1150 W DALLAS ST
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77301-2208
Practice Address - Country:US
Practice Address - Phone:713-955-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-03
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704317818163W00000X, 363LF0000X
TX1123912363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily