Healthcare Provider Details

I. General information

NPI: 1487589784
Provider Name (Legal Business Name): KRIS IGANCIO ALONSO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 PLAZA BLVD APT 31
KEARNEY NE
68845-4812
US

IV. Provider business mailing address

1820 5TH AVE
KEARNEY NE
68845-5929
US

V. Phone/Fax

Practice location:
  • Phone: 308-234-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: