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DR. KEVIN RICHARD KRACKE PH.D. NPI 1164416749


NPI Information

NPI: 1164416749
Provider Name: DR. KEVIN RICHARD KRACKE, PH.D.
Classification: Psychologist - 103T00000X
Entity Type: Individual

PECOS Registration: Yes

Address:
422 17TH ST
LEWISTON, ID
ZIP 83501
Phone: (208) 743-4680
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DR. Kevin Richard Kracke, PH.D. is a psychologist in Lewiston, ID with 44 years of experience. The provider is a psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. DR. Kevin Richard Kracke, PH.D. NPI is 1164416749. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

422 17TH ST
LEWISTON, ID
ZIP 83501-526
Phone: (208) 743-4680
Fax: (208) 743-1756

The NPI 1164416749 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment.

The enumeration date for this NPI number is 9/9/2005 and was last updated on 3/15/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1103T00000XPsychologistPSY189IDAHOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1806177700MEDICAIDIDAHO
2000010015963OTHERIDAHOBLUESHIELD OF IDAHO
31376238MEDICARE ID-TYPE UNSPECIFIEDIDAHOCIGNA MEDICARE
4N4478OTHERIDAHOBLUE CROSS OF IDAHO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.