Healthcare Provider Details

I. General information

NPI: 1669160743
Provider Name (Legal Business Name): KJIRSTEN R ERVI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5908 S 142ND ST
OMAHA NE
68137-2800
US

IV. Provider business mailing address

825 S 169TH ST FL 3
OMAHA NE
68118-9300
US

V. Phone/Fax

Practice location:
  • Phone: 402-354-1900
  • Fax: 402-354-1910
Mailing address:
  • Phone: 402-354-4822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number80264
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA176479
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number115483
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: