Provider Demographics
NPI:1245705227
Name:CUNNINGHAM, KRISTY LYNN (RN,BSN)
Entity type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LYNN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:RN,BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 WHITMORE ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68152-2250
Mailing Address - Country:US
Mailing Address - Phone:531-299-2361
Mailing Address - Fax:
Practice Address - Street 1:6143 WHITMORE ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68152-2250
Practice Address - Country:US
Practice Address - Phone:531-299-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE49215163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool