Provider Demographics
NPI:1952533861
Name:HASTINGS, KELLY CHRISTINE (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:CHRISTINE
Last Name:HASTINGS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:CHRISTINE
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8303 DODGE ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-4108
Mailing Address - Country:US
Mailing Address - Phone:402-354-8124
Mailing Address - Fax:402-393-2161
Practice Address - Street 1:8303 DODGE ST
Practice Address - Street 2:SUITE 250
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4108
Practice Address - Country:US
Practice Address - Phone:402-354-8124
Practice Address - Fax:402-393-2161
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2009-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111056363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE24209OtherBC/BS PROVIDER #
086200005Medicare PIN
NA1217005Medicare PIN