Provider Demographics
NPI:1538113758
Name:KRUEGER, HEATHER G (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:G
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1869
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-1869
Mailing Address - Country:US
Mailing Address - Phone:828-687-5616
Mailing Address - Fax:828-650-8076
Practice Address - Street 1:50 HOSPITAL DR
Practice Address - Street 2:STE 5D
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-5248
Practice Address - Country:US
Practice Address - Phone:828-650-8032
Practice Address - Fax:828-650-8033
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16412174400000X
NC200800947208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC151K1OtherBCBS NC
NC5909690Medicaid
NCP01376870OtherMEDICARE RR
SC16412OtherSC MEDICAL LIC #
SCA53452Medicare UPIN
NCNCK158AMedicare PIN