Provider Demographics
NPI:1265322416
Name:KISTLER, MICHAEL BRADLEY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BRADLEY
Last Name:KISTLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4226 D ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-4722
Mailing Address - Country:US
Mailing Address - Phone:402-450-6631
Mailing Address - Fax:
Practice Address - Street 1:4226 D ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4722
Practice Address - Country:US
Practice Address - Phone:402-450-6631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist