Basic Information
| Provider Information | |||||||||
| NPI: | 1437668852 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRUEGER | ||||||||
| FirstName: | JESSIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RN FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 300 N OSAGE ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | INDEPENDENCE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640502705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8133562000 | ||||||||
| FaxNumber: | 8167371796 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 RAINBOW BLVD | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 661608500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9135885000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2017 | ||||||||
| LastUpdateDate: | 01/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | 2015031281 | MO | N | Nursing Service Providers | Registered Nurse | General Practice | 163WG0000X | 105000 | KS | N | Nursing Service Providers | Registered Nurse | General Practice | 363LF0000X | 53-77901 | KS | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 2017033616 | MO | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 2017033616 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.