Provider Demographics
NPI:1679290696
Name:SIMON, KRISTIN LYNN (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:LYNN
Last Name:SIMON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:LYNN
Other - Last Name:KLOPPENBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, FNP-C
Mailing Address - Street 1:6707 S 209TH ST
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-2983
Mailing Address - Country:US
Mailing Address - Phone:402-679-1198
Mailing Address - Fax:
Practice Address - Street 1:3929 S 147TH ST STE 100Q
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-5529
Practice Address - Country:US
Practice Address - Phone:402-997-0772
Practice Address - Fax:855-631-3719
Is Sole Proprietor?:No
Enumeration Date:2022-10-20
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114619363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS7814165OtherDEA