Provider Demographics
NPI:1356093561
Name:KRACHT, JESSE
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:
Last Name:KRACHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12592 U RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NE
Mailing Address - Zip Code:68662-8010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12592 U RD
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NE
Practice Address - Zip Code:68662-8010
Practice Address - Country:US
Practice Address - Phone:402-689-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer