Provider Demographics
NPI:1376625541
Name:KRUSE, JUDI M (APRN,BC)
Entity Type:Individual
Prefix:
First Name:JUDI
Middle Name:M
Last Name:KRUSE
Suffix:
Gender:F
Credentials:APRN,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPAWINGO
Mailing Address - State:MO
Mailing Address - Zip Code:64015-9686
Mailing Address - Country:US
Mailing Address - Phone:816-803-8542
Mailing Address - Fax:
Practice Address - Street 1:1200 W 22ND ST
Practice Address - Street 2:
Practice Address - City:HIGGINSVILLE
Practice Address - State:MO
Practice Address - Zip Code:64037-1420
Practice Address - Country:US
Practice Address - Phone:660-584-7751
Practice Address - Fax:660-584-8261
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN075514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428502108Medicaid
MO1509870Medicare PIN
S79442Medicare UPIN