Provider Demographics
NPI:1679697346
Name:KROEKER, KERRY A (APRN BC FNP GNP)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:A
Last Name:KROEKER
Suffix:
Gender:F
Credentials:APRN BC FNP GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W MORRISON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FAYETTE
Mailing Address - State:MO
Mailing Address - Zip Code:65248-1075
Mailing Address - Country:US
Mailing Address - Phone:660-248-2900
Mailing Address - Fax:660-248-1544
Practice Address - Street 1:600 W MORRISON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1075
Practice Address - Country:US
Practice Address - Phone:660-248-2900
Practice Address - Fax:660-248-1544
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO140382174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist