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KEEGAN WARREN KRUCKEBERG MD
NPI 1891540480
Student in an Organized Health Care Education/Training Program in Memphis, TN

Active since April 18, 2024PECOS Enrolled
920 MADISON AVENUE SUITE 447, MEMPHIS, TN 38103(901) 448-0230 Get Directions Write a Review

NPPES record last updated: April 18, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Keegan Warren Kruckeberg Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KEEGAN WARREN KRUCKEBERG MD (NPI 1891540480) is an individual student in an organized health care education/training program in Memphis, Tennessee and active in the NPI registry since April 2024. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1891540480
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameKEEGAN WARREN KRUCKEBERGCredential: MD
Location Address920 MADISON AVENUE SUITE 447Memphis, TN 38103
Mailing Address1301 Primacy PkwyMemphis, TN 38119-0213
Phone(901) 448-0230
Sole ProprietorNo
Enumeration DateApril 18, 2024
NPPES CertifiedApril 18, 2024
✔ NPI 1891540480 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
920 MADISON AVENUE SUITE 447, Memphis, TN 38103
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Keegan Warren Kruckeberg Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Keegan Kruckeberg's NPI number?

The NPI number for Keegan Kruckeberg is 1891540480. It was assigned to this individual provider in the NPPES registry on April 18, 2024.

Where is Keegan Kruckeberg located?

Keegan Kruckeberg practices at 920 Madison Avenue Suite 447, Memphis, TN 38103. The listed phone number is (901) 448-0230.

What is Keegan Kruckeberg's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Keegan Kruckeberg enrolled in Medicare?

Yes. Keegan Kruckeberg is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Keegan Kruckeberg was last updated on April 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.