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Individual
MRS. KELLY BAILEY KRUSE
Active
Individual
MRS. KELLY BAILEY KRUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
496
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0655PA
—
SC
01
—
P00615390
RAILROAD MEDICARE ID
SC
01
—
P00727284
RAILROAD MEDICARE ID-RSFPP
SC
Enumeration date
07/12/2006
Last updated
04/25/2025
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