Provider Demographics
NPI:1467892679
Name:KEVIN D KRUGER
Entity Type:Organization
Organization Name:KEVIN D KRUGER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:361-318-1617
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:NORMANNA
Mailing Address - State:TX
Mailing Address - Zip Code:78142-0143
Mailing Address - Country:US
Mailing Address - Phone:361-318-1617
Mailing Address - Fax:
Practice Address - Street 1:1711 W WHEELER AVE
Practice Address - Street 2:
Practice Address - City:ARANSAS PASS
Practice Address - State:TX
Practice Address - Zip Code:78336-4536
Practice Address - Country:US
Practice Address - Phone:361-318-1617
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty