Individual
JUDYANN KRENNING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
600 BLUES LAKE PKWY, ROLLA, MO 65401-8022
(573) 364-8822
(573) 341-5969
Mailing address
600 BLUES LAKE PKWY, ROLLA, MO 65401-8022
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
114610
MO
207YX0602X
Otolaryngic Allergy Physician
114610
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
209748516
—
MO
01
—
3347A1
BLUE CROSS BLUE SHIELD
MO
01
—
383115
HEALTHLINK
MO
01
—
P00071667
RAILROAD MEDICARE
MO
Enumeration date
07/21/2006
Last updated
03/10/2020
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