Provider Demographics
NPI:1710033642
Name:KRALL, CHARLES ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ANTHONY
Last Name:KRALL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 30TH DR
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-4602
Mailing Address - Country:US
Mailing Address - Phone:620-423-0033
Mailing Address - Fax:
Practice Address - Street 1:426 W 14TH ST
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-2878
Practice Address - Country:US
Practice Address - Phone:620-423-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLP536103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS119835OtherBLUE CROSS BLUE SHIELD
KS255787OtherCOMPSYCH
KS073979OtherMHS VALUE OPTIONS
KS119710OtherLABETTE MH BLUE CROSS
KS119835OtherBLUE CROSS BLUE SHIELD
KS119835Medicare ID - Type UnspecifiedPRIVATE PRACTICE MEDICARE