Healthcare Provider Details

I. General information

NPI: 1588320238
Provider Name (Legal Business Name): KRISTEN ADKINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 PORT GRACE BLVD STE 101
LA VISTA NE
68128-3190
US

IV. Provider business mailing address

1506 S 152ND AVENUE CIR
OMAHA NE
68144-5115
US

V. Phone/Fax

Practice location:
  • Phone: 402-645-0038
  • Fax: 402-925-3936
Mailing address:
  • Phone: 402-645-0038
  • Fax: 402-925-3936

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number13884
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: