Healthcare Provider Details

I. General information

NPI: 1639009608
Provider Name (Legal Business Name): KIERSTYN EVERS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIERSTYN RIEF

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10819 S 204TH AVENUE CIR STE 1
GRETNA NE
68028-4048
US

IV. Provider business mailing address

1737 ITHACA AVE
MONDAMIN IA
51557-4102
US

V. Phone/Fax

Practice location:
  • Phone: 531-359-2205
  • Fax:
Mailing address:
  • Phone: 402-319-6088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17193
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: