Basic Information
| Provider Information | |||||||||
| NPI: | 1538113758 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUEGER | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1869 | ||||||||
| Address2: | |||||||||
| City: | FLETCHER | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287321869 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286875616 | ||||||||
| FaxNumber: | 8286508076 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 HOSPITAL DR | ||||||||
| Address2: | STE 5D | ||||||||
| City: | HENDERSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287925248 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8286508032 | ||||||||
| FaxNumber: | 8286508033 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 10/25/2016 | ||||||||
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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 | 174400000X | 16412 | SC | N | Other Service Providers | Specialist | 208000000X | 200800947 | NC | Y | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 200800947 | NC | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 151K1 | 01 | NC | BCBS NC | OTHER | 5909690 | 05 | NC | MEDICAID | P01376870 | 01 | NC | MEDICARE RR | OTHER | 16412 | 01 | SC | SC MEDICAL LIC # | OTHER |