Provider Demographics
NPI:1255823316
Name:KRAUS, TEEGAN R (PA-C)
Entity type:Individual
Prefix:
First Name:TEEGAN
Middle Name:R
Last Name:KRAUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040-9129
Mailing Address - Country:US
Mailing Address - Phone:262-626-4616
Mailing Address - Fax:
Practice Address - Street 1:889 E JOHNSON ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-2933
Practice Address - Country:US
Practice Address - Phone:920-367-6700
Practice Address - Fax:262-700-4657
Is Sole Proprietor?:No
Enumeration Date:2018-06-05
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
WI4432363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant