Basic Information
| Provider Information | |||||||||
| NPI: | 1003801416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAHL | ||||||||
| FirstName: | VICKIE | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LSA | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3320 COLORADO BLVD | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762106864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403826757 | ||||||||
| FaxNumber: | 9403831894 | ||||||||
| Practice Location | |||||||||
| Address1: | 3320 COLORADO BLVD | ||||||||
| Address2: | |||||||||
| City: | DENTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762106864 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9403826757 | ||||||||
| FaxNumber: | 9403831894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZS0410X | SA0003 | TX | Y |
ID Information
| ID | Type | State | Issuer | Description | 89N936 | 01 | TX | BCBS | OTHER |