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 Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 251V00000X | Voluntary or Charitable | | | | Yes |
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 Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 27506 | OTHER | NORTH DAKOTA | KATHRYN KRUKENBERG BCBS |
| 2 | 74005 | MEDICAID | NORTH DAKOTA | |
| 3 | 27507 | OTHER | NORTH DAKOTA | AMY FAST TRIWEST PIN |
| 4 | 19167 | MEDICAID | NORTH DAKOTA | |
| 5 | 27505 | OTHER | NORTH DAKOTA | LAVONNA FUCHS - BCBS PIN |
| 6 | 74003 | MEDICAID | NORTH DAKOTA | |
| 7 | 27506 | OTHER | NORTH DAKOTA | KATHRYN KRUKENBERG TRIWES |
| 8 | 27507 | OTHER | NORTH DAKOTA | AMY FAST BCBS PIN |
| 9 | 74004 | MEDICAID | NORTH DAKOTA | |
| 10 | 27505 | OTHER | NORTH DAKOTA | TRIWEST PIN |
| 11 | 50602 | MEDICAID | NORTH DAKOTA | |
| 12 | 74006 | MEDICAID | NORTH DAKOTA | |
