Basic Information
| Provider Information | |||||||||
| NPI: | 1013270867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VON KRIEGENBERGH | ||||||||
| FirstName: | KATRINA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | TEXAS TECH UNIVERSITY HEALTH SCIENCES CTR | ||||||||
| Address2: | 3601 4TH STREET STOP 8182 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432981 | ||||||||
| FaxNumber: | 8067432984 | ||||||||
| Practice Location | |||||||||
| Address1: | TEXAS TECH UNIVERSITY HEALTH SCIENCES CTR | ||||||||
| Address2: | 3601 4TH STREET STOP 8182 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432981 | ||||||||
| FaxNumber: | 8067432984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2012 | ||||||||
| LastUpdateDate: | 08/02/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | BP10043355 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | BP20058299 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.