Doctor Name: | CARRIE ANN KRALICEK |
NPI Number: | 1164860383 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PMHNP-BC |
License Number: | IP60386649 |
Business Practice Address: | 153 N Broadway Coos Bay, OR - 974201633 |
Business Phone Number: | 5418089599 |
Business Fax Number: | 5418089559 |
Mailing Address: | 153 N Broadway, COOS BAY |
State: | OR |
Postal Code: | 974201633 |
Phone Number: | 5418089599 |
Fax Number: | 5418089559 |
NPI Enumeration Date: | 06/10/2013 |
NPI Last Update Date: | 05/14/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | IP60386649 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |