Provider Demographics
NPI:1922005586
Name:KREGER, JENNIFER BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BETH
Last Name:KREGER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721-A RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5403
Mailing Address - Country:US
Mailing Address - Phone:707-961-4631
Mailing Address - Fax:707-964-1192
Practice Address - Street 1:721-A RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5403
Practice Address - Country:US
Practice Address - Phone:707-961-4631
Practice Address - Fax:707-964-1192
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG077877207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G077877Medicaid
CA00G077877Medicaid
CAG35299Medicare UPIN