Provider Demographics
NPI:1417758277
Name:HARPER, KRYSTYON
Entity type:Individual
Prefix:
First Name:KRYSTYON
Middle Name:
Last Name:HARPER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KRYSSY
Other - Middle Name:
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2939 BLONDO ST APT 103
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-4174
Mailing Address - Country:US
Mailing Address - Phone:531-800-3341
Mailing Address - Fax:
Practice Address - Street 1:17702 PEBBLE CIR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68136-1528
Practice Address - Country:US
Practice Address - Phone:531-800-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE850622863747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider