Provider Demographics
NPI:1992484851
Name:MOONSTONE PSYCHIATRIC SERVICES, LLC
Entity type:Organization
Organization Name:MOONSTONE PSYCHIATRIC SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EMEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:402-624-4287
Mailing Address - Street 1:3883 NORMAL BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-5218
Mailing Address - Country:US
Mailing Address - Phone:402-624-4287
Mailing Address - Fax:402-702-1561
Practice Address - Street 1:3883 NORMAL BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-5218
Practice Address - Country:US
Practice Address - Phone:402-624-4287
Practice Address - Fax:402-702-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-17
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10027783000Medicaid