Provider Demographics
NPI:1679860167
Name:KRAJICEK, KRISTINA ALEXIS (PAC)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ALEXIS
Last Name:KRAJICEK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:ALEXIS
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PAC
Mailing Address - Street 1:2727 S 144TH ST., #240
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144
Mailing Address - Country:US
Mailing Address - Phone:402-609-1200
Mailing Address - Fax:402-609-1220
Practice Address - Street 1:2727 S 144TH ST STE 240
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5201
Practice Address - Country:US
Practice Address - Phone:402-609-1200
Practice Address - Fax:402-609-1220
Is Sole Proprietor?:No
Enumeration Date:2011-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant