Provider Demographics
NPI:1801813498
Name:CRUSE, KAYE E (RN, MSN, ENP)
Entity Type:Individual
Prefix:
First Name:KAYE
Middle Name:E
Last Name:CRUSE
Suffix:
Gender:F
Credentials:RN, MSN, ENP
Other - Prefix:
Other - First Name:KAYE
Other - Middle Name:E
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1100 E DIMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-2010
Mailing Address - Country:US
Mailing Address - Phone:907-565-6000
Mailing Address - Fax:907-565-6000
Practice Address - Street 1:3841 PIPER ST
Practice Address - Street 2:SUITE T-345
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4624
Practice Address - Country:US
Practice Address - Phone:907-565-6000
Practice Address - Fax:907-565-6000
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK980363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044357401Medicaid
TX044357404Medicaid
TX044357402Medicaid
TX85N285Medicare PIN
TX84P574Medicare PIN
P15242Medicare UPIN
TX044357404Medicaid