Provider Demographics
NPI:1831636711
Name:KRUEGER, KALAN ELIZABETH (NP)
Entity Type:Individual
Prefix:
First Name:KALAN
Middle Name:ELIZABETH
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 HUNTSVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334-3603
Mailing Address - Country:US
Mailing Address - Phone:931-297-2201
Mailing Address - Fax:931-297-2206
Practice Address - Street 1:1321 HUNTSVILLE HWY
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334-3603
Practice Address - Country:US
Practice Address - Phone:931-297-2201
Practice Address - Fax:931-297-2206
Is Sole Proprietor?:No
Enumeration Date:2017-01-30
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP4952363L00000X
MN4952363L00000X
TN32522363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner