Provider Demographics
NPI:1326214982
Name:KRUEGER, CARLA DALE (FNP-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:DALE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HEALTH CENTER ROAD
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:SD
Mailing Address - Zip Code:57752-0000
Mailing Address - Country:US
Mailing Address - Phone:605-455-2451
Mailing Address - Fax:605-455-1529
Practice Address - Street 1:1000 HEALTH CENTER ROAD
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:SD
Practice Address - Zip Code:57752-0000
Practice Address - Country:US
Practice Address - Phone:605-455-2451
Practice Address - Fax:605-455-1529
Is Sole Proprietor?:No
Enumeration Date:2008-05-05
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR034054163W00000X
SDCP000939363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse