MR. CLARKE KRUGMAN (NPI# 1518357730) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518357730 |
| Entity Type | Individual |
| Full Name | MR. CLARKE KRUGMAN |
| Credential | AGNP-C CNS NE |
| Practice Address |
1003 Division St Ste 8 Prescott AZ 86301-1657 |
| Mailing Address |
6974 E Lynx Wagon Rd Prescott Valley AZ 86314-1933 |
| Practice Telephone | 9285150804 |
| Mailing Telephone | 9287138385 |
| Enumeration Date | 2015-01-26 |
| Last Update Date | 2019-12-19 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | RN178676 | AZ | Nursing Service Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
226313 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LG0600X |
Nurse Practitioner Specialization: Gerontology |
226313 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 6974 E Lynx Wagon Rd, Prescott Valley, AZ 863141933 | 9287138385 |
| Street Address |
1003 DIVISION ST STE 8 |
| City | PRESCOTT |
| State | AZ |
| Zip Code | 86301-1657 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114575578 | Vitality Care Center Pllc | Family Medicine | 1003 Division St Ste 8, Prescott, AZ 86301-1657 | 2019-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871102350 | Dove Marie Gundermann | Specialist/Technologist | 300 W. Gurley St, Prescott, AZ 86301 | 2020-07-30 |
| 1639712110 | Arizona Orthopedic Physical Therapy, Pllc | Clinic/Center | 1781 E State Highway 69, Suite 28, Prescott, AZ 86301 | 2019-10-28 |
| 1538714092 | Prescott Complete Care | Family Medicine | 1947 Commerce Center Circle, Suite A, Prescott, AZ 86301 | 2019-08-01 |
| 1336612571 | Sarah Elizabeth Elliott | Registered Nurse | 500 Az 89, Prescott, AZ 86301 | 2019-01-10 |
| 1912484270 | Asya Ruth Perkins | Counselor | 225 Grove Avenue, Prescott, AZ 86301 | 2018-07-19 |
| 1396241394 | Jerome Alexander Longoria | Chiropractor | 142 N. Rush St, Prescott, AZ 86301 | 2018-03-30 |
| 1619487675 | Yavapai Healthcare Group LLC | Nurse Practitioner | 999 Division Street, Prescott, AZ 86301 | 2017-10-04 |
| 1053835843 | United States Veterans Initiative | Counselor | 917 E Gurley St, Prescott, AZ 86301 | 2017-08-02 |
| 1164896999 | Spitler - Lilley, LLC | Hearing Instrument Specialist | 1781 E. State Rte 69, Suite 65, Prescott, AZ 86301 | 2015-11-17 |
| 1275925265 | Oral and Facial Surgery Center of Prescott | Dentist | 5415 Distiction Way, Prescott, AZ 86301 | 2015-02-27 |
| Find all providers in zip 86301 | ||||
| Taxonomy Code | 363LG0600X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Gerontology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184630865 | Karen A. Burton | Nurse Practitioner | 1400 N Acres Rd Ste 30, Prescott, WI 54021-7039 | 2006-08-01 |
| 1538725916 | Utibe Joshua Etudor | Nurse Practitioner | 810 Ainsworth Dr Ste A, Prescott, AZ 86301-1612 | 2019-05-11 |
| 1144697301 | Carol G Underwood | Nurse Practitioner | 1484 W 1st St N, Prescott, AR 71857-3339 | 2015-08-24 |
| 1144329905 | Mary Ann Bell | Nurse Practitioner | 500 Highway 89, Northnorthern Arizona Va Health Care System, Prescott, AZ 86313 | 2006-09-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104425123 | Erin Jean Mcmanus-tomanek | Nurse Practitioner | 12851 N 142nd Ave, Surprise, AZ 85379-9502 | 2020-10-21 |
| 1154928463 | Willie Sellers | Nurse Practitioner | 15354 W Charter Oak Rd, Surprise, AZ 85379-9184 | 2020-10-08 |
| 1760090427 | Debra Shannon Witthar | Nurse Practitioner | 10515 W Santa Fe Dr Bldg B, Sun City, AZ 85351-3020 | 2020-07-20 |
| 1255955506 | Christy J Holloway | Nurse Practitioner | 2645 E Southern Ave, Tempe, AZ 85282-7649 | 2020-06-02 |
| 1013552124 | Alliance With The Covenant of The Trinity Arizona Inc | Nurse Practitioner | 2 N Central Ave Fl 18, Phoenix, AZ 85004-2322 | 2019-11-12 |
| 1184197691 | Waheed Olawoyin Olabode | Nurse Practitioner | 12853 S 184th Ave, Goodyear, AZ 85338-2642 | 2019-01-08 |
| 1508381880 | Marcie Marie Camblin | Nurse Practitioner | 16551 N Naegel Dr, Surprise, AZ 85374-5411 | 2017-08-08 |
| 1508105727 | Geriatric Health Services, Plc | Nurse Practitioner | 1013 W Longhorn Rd, Payson, AZ 85541-4282 | 2013-02-07 |
| 1194070227 | Debra Rouse Haber | Nurse Practitioner | 755 S Grapevine Loop, Benson, AZ 85602-7430 | 2012-07-15 |
| 1346504818 | Your Nurse Practitioner LLC | Nurse Practitioner | 6261 Boothwyn St, Prescott Valley, AZ 86314-6726 | 2012-06-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.