Provider Demographics
NPI:1124142443
Name:JAHNKE, KRISTINE KAY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KRISTINE
Middle Name:KAY
Last Name:JAHNKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 HIGHWAY 9
Mailing Address - Street 2:
Mailing Address - City:BANCROFT
Mailing Address - State:NE
Mailing Address - Zip Code:68004-4059
Mailing Address - Country:US
Mailing Address - Phone:402-648-7548
Mailing Address - Fax:
Practice Address - Street 1:500 E DECATUR ST
Practice Address - Street 2:
Practice Address - City:WEST POINT
Practice Address - State:NE
Practice Address - Zip Code:68788-1565
Practice Address - Country:US
Practice Address - Phone:402-372-2404
Practice Address - Fax:402-372-6770
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE431363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NED38830OtherFRHS BCBS
NE47079687513Medicaid
2732OtherFRHS MIDLANDS CHOICE
2732OtherFRHS MIDLANDS CHOICE
R81633Medicare UPIN
NE276707Medicare ID - Type UnspecifiedFRHS