Healthcare Provider Details

I. General information

NPI: 1124142443
Provider Name (Legal Business Name): KRISTINE KAY JAHNKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 03/07/2023
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E DECATUR ST
WEST POINT NE
68788-1565
US

IV. Provider business mailing address

1922 HIGHWAY 9
BANCROFT NE
68004-4059
US

V. Phone/Fax

Practice location:
  • Phone: 402-372-2404
  • Fax: 402-372-6770
Mailing address:
  • Phone: 402-648-7548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number431
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: