Provider Demographics
NPI:1396061719
Name:ECKHART, KRYSTLE A (PSYD, LP)
Entity type:Individual
Prefix:DR
First Name:KRYSTLE
Middle Name:A
Last Name:ECKHART
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:A
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD, LP
Mailing Address - Street 1:7100 W CENTER RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2714
Mailing Address - Country:US
Mailing Address - Phone:402-506-9000
Mailing Address - Fax:402-315-2707
Practice Address - Street 1:7100 W CENTER RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68106-2714
Practice Address - Country:US
Practice Address - Phone:402-506-9000
Practice Address - Fax:402-315-2707
Is Sole Proprietor?:No
Enumeration Date:2010-04-09
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015016431103TC0700X
NE955103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1327154Medicare PIN
MO501150121Medicare PIN