Provider Demographics
NPI:1881367837
Name:HENRY, KRISTA LYNN (APRN)
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LYNN
Last Name:HENRY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9614 S 171ST AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1494
Mailing Address - Country:US
Mailing Address - Phone:712-870-9788
Mailing Address - Fax:
Practice Address - Street 1:5715 S 34TH ST STE 400
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6696
Practice Address - Country:US
Practice Address - Phone:402-802-7843
Practice Address - Fax:402-261-9122
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113210363LA2200X, 363LP0808X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care