Provider Demographics
NPI:1144034695
Name:CARLSON, KRISTAL ELLEN (RN)
Entity type:Individual
Prefix:
First Name:KRISTAL
Middle Name:ELLEN
Last Name:CARLSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:ONEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763-2221
Mailing Address - Country:US
Mailing Address - Phone:402-336-8486
Mailing Address - Fax:
Practice Address - Street 1:318 E HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:ONEILL
Practice Address - State:NE
Practice Address - Zip Code:68763-2104
Practice Address - Country:US
Practice Address - Phone:402-336-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-05
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE43597163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice