Provider Demographics
NPI:1265999783
Name:KROCK, MICHELLE E (ARNP, FNP-C)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:E
Last Name:KROCK
Suffix:
Gender:F
Credentials:ARNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 METROPOLITAN AVE
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-1254
Mailing Address - Country:US
Mailing Address - Phone:913-682-8700
Mailing Address - Fax:913-578-1009
Practice Address - Street 1:1300 METROPOLITAN AVE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-1254
Practice Address - Country:US
Practice Address - Phone:913-682-8700
Practice Address - Fax:913-578-1009
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78586363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily