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General NPI Number Information
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NPI Number | 1467618868
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Entity Type | Individual
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Provider Name | JASON A KRIST ARNP
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Gender | Male
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Dates
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Enumeration Date | 08/05/2008
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 711 S VINE ST GLENWOOD RESOURCE CENTER, STATE OF IOWA
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City | GLENWOOD
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State | IA
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Zip | 51534-1927
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Country | US
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Telephone | 712-525-1855
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Fax |
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Provider Business Mailing Address
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Address Line | 17722 LILLIAN ST
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City | OMAHA
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State | NE
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Zip | 68136-2051
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Country | US
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Telephone | 402-932-6070
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 1821
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 110979
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A-121972
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License Number State | IA
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