Basic Information
| Provider Information | |||||||||
| NPI: | 1679860167 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAJICEK | ||||||||
| FirstName: | KRISTINA | ||||||||
| MiddleName: | ALEXIS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PAC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WEST | ||||||||
| OtherFirstName: | KRISTINA | ||||||||
| OtherMiddleName: | ALEXIS | ||||||||
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| OtherCredential: | PAC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2727 S 144TH ST., #240 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 68144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026091200 | ||||||||
| FaxNumber: | 4026091220 | ||||||||
| Practice Location | |||||||||
| Address1: | 2727 S 144TH ST STE 240 | ||||||||
| Address2: | |||||||||
| City: | OMAHA | ||||||||
| State: | NE | ||||||||
| PostalCode: | 681445201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4026091200 | ||||||||
| FaxNumber: | 4026091220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2011 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1597 | NE | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.