Healthcare Provider Details

I. General information

NPI: 1043946171
Provider Name (Legal Business Name): KIERSTEN LEIGHA LONGCHAMPS AGACNP/APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 DEWEY AVE
OMAHA NE
68105-1017
US

IV. Provider business mailing address

988102 NEBRASKA MEDICAL CTR
OMAHA NE
68198-8102
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number114315
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: