Individual
CARMEL C KRUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNPBC
Contact information
Practice address
228 BUCHER DR, MOUNTAIN HOME, AR 72653-3400
(870) 425-4416
(870) 425-8615
Mailing address
PO BOX 2038, MOUNTAIN HOME, AR 72654-2038
(870) 425-4416
(870) 425-8615
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
A03030
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06-1833974
TAX ID
—
01
—
1720271711
UPIN
AR
05
—
175377758
—
AR
01
—
5A587
BCBS
AR
01
—
5A587
ARBC
—
01
—
A03030
LISCENSE
AR
Enumeration date
08/22/2007
Last updated
03/07/2023
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