Provider Demographics
NPI:1255391751
Name:KRUG, KENT MICHAEL (DC, MSN, FNP-BC, NPC)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:MICHAEL
Last Name:KRUG
Suffix:
Gender:M
Credentials:DC, MSN, FNP-BC, NPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HEBER SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72543-2926
Mailing Address - Country:US
Mailing Address - Phone:501-362-6859
Mailing Address - Fax:501-362-5735
Practice Address - Street 1:801 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HEBER SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72543-2926
Practice Address - Country:US
Practice Address - Phone:501-362-6859
Practice Address - Fax:501-362-5735
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1078111N00000X
ARA163508363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR350013492OtherRAILROAD MEDICARE ID
AR44-20043OtherUNITED HEALTHCARE ID
AR1569200004OtherQUALCHOICE ID
AR112917718Medicaid
AR4212267467254300OtherTRICARE
AR1569200004OtherQUALCHOICE ID
ART20608Medicare UPIN