Provider Demographics
NPI:1467618868
Name:KRIST, JASON A (ARNP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:KRIST
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17722 LILLIAN ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-2051
Mailing Address - Country:US
Mailing Address - Phone:402-932-6070
Mailing Address - Fax:
Practice Address - Street 1:711 S VINE ST
Practice Address - Street 2:GLENWOOD RESOURCE CENTER, STATE OF IOWA
Practice Address - City:GLENWOOD
Practice Address - State:IA
Practice Address - Zip Code:51534-1927
Practice Address - Country:US
Practice Address - Phone:712-525-1855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1821363L00000X
NE110979363LF0000X
IAA-121972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner