Provider Demographics
NPI:1093141632
Name:STEVENS, KRISTY KAYE (RT (R))
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:KAYE
Last Name:STEVENS
Suffix:
Gender:F
Credentials:RT (R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5052 GROVER ST APT 12
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3844
Mailing Address - Country:US
Mailing Address - Phone:308-730-1777
Mailing Address - Fax:
Practice Address - Street 1:5052 GROVER ST APT 12
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-3844
Practice Address - Country:US
Practice Address - Phone:308-730-1777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-14
Last Update Date:2013-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE44452471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography