Provider Demographics
NPI:1487032181
Name:STOECKER, KRISTA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTA
Middle Name:MARIE
Last Name:STOECKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W 14TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HOLDREGE
Mailing Address - State:NE
Mailing Address - Zip Code:68949-1215
Mailing Address - Country:US
Mailing Address - Phone:308-995-4431
Mailing Address - Fax:308-995-5912
Practice Address - Street 1:516 W 14TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOLDREGE
Practice Address - State:NE
Practice Address - Zip Code:68949-1215
Practice Address - Country:US
Practice Address - Phone:308-995-4431
Practice Address - Fax:308-995-5912
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE30929207Q00000X
NE7390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1487032181Medicaid