Provider Demographics
NPI:1871821629
Name:KRATZER, SHANNON L (FNP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:KRATZER
Suffix:
Gender:F
Credentials:FNP
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 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:812-473-5822
Practice Address - Street 1:3799 VENETIAN WAY
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-8278
Practice Address - Country:US
Practice Address - Phone:812-471-4302
Practice Address - Fax:812-471-4303
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003131A207Q00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000842553OtherANTHEM
IN201147000Medicaid
INP01263641OtherRAILROAD MEDICARE
ININ1615002Medicare PIN