1952533861 NPI number — KELLY CHRISTINE HASTINGS APRN

Table of content: KELLY CHRISTINE HASTINGS APRN (NPI 1952533861)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952533861 NPI number — KELLY CHRISTINE HASTINGS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HASTINGS
Provider First Name:
KELLY
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASEY
Provider Other First Name:
KELLY
Provider Other Middle Name:
CHRISTINE
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:
1952533861
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8303 DODGE ST
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68114-4108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-354-8124
Provider Business Mailing Address Fax Number:
402-393-2161

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8303 DODGE ST
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68114-4108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-354-8124
Provider Business Practice Location Address Fax Number:
402-393-2161
Provider Enumeration Date:
08/12/2009

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: 363L00000X , with the licence number:  111056 , 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: 24209 . This is a "BC/BS PROVIDER #" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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