Provider Demographics
NPI:1720271711
Name:KRUSE, CARMEL C (FNPBC)
Entity Type:Individual
Prefix:
First Name:CARMEL
Middle Name:C
Last Name:KRUSE
Suffix:
Gender:F
Credentials:FNPBC
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 2038
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72654-2038
Mailing Address - Country:US
Mailing Address - Phone:870-425-4416
Mailing Address - Fax:870-425-8615
Practice Address - Street 1:228 BUCHER DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3400
Practice Address - Country:US
Practice Address - Phone:870-425-4416
Practice Address - Fax:870-425-8615
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03030363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR175377758Medicaid
06-1833974OtherTAX ID
AR5A587OtherBCBS
ARA03030OtherLISCENSE
5A587OtherARBC
AR1720271711OtherUPIN
AR1720271711OtherUPIN
AR5A587OtherBCBS