1093449241 NPI number — CHRIS LINDA KAST

Table of content: CHRIS LINDA KAST (NPI 1093449241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093449241 NPI number — CHRIS LINDA KAST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAST
Provider First Name:
CHRIS
Provider Middle Name:
LINDA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAST
Provider Other First Name:
CHRISSAN
Provider Other Middle Name:
LINDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093449241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 W. NORFOLK AVE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68701-5221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-379-2030
Provider Business Mailing Address Fax Number:
402-379-3933

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 W. NORFOLK AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
NORFOLK
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68701-5221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-379-2030
Provider Business Practice Location Address Fax Number:
402-379-3933
Provider Enumeration Date:
07/13/2022

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: 171M00000X , with the licence number:  CPSS-170 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175T00000X , with the licence number: CPSS-170 , 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)

  • Identifier: 39189435426 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".