1396061719 NPI number — DR. KRYSTLE A ECKHART PSY.D., LP

Table of content: DR. KRYSTLE A ECKHART PSY.D., LP (NPI 1396061719)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396061719 NPI number — DR. KRYSTLE A ECKHART PSY.D., LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ECKHART
Provider First Name:
KRYSTLE
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D., LP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROBINSON
Provider Other First Name:
KRYSTLE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D., LP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396061719
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7100 W CENTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68106-2714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-506-9000
Provider Business Mailing Address Fax Number:
402-315-2707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7100 W CENTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68106-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-506-9000
Provider Business Practice Location Address Fax Number:
402-315-2707
Provider Enumeration Date:
04/09/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  2015016431 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X , with the licence number: 955 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)