Provider Demographics
NPI:1174413645
Name:CALLAHAN, KRISTINE JEAN
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:JEAN
Last Name:CALLAHAN
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:COZAD
Mailing Address - State:NE
Mailing Address - Zip Code:69130-1609
Mailing Address - Country:US
Mailing Address - Phone:531-777-9404
Mailing Address - Fax:
Practice Address - Street 1:416 E 13TH ST
Practice Address - Street 2:
Practice Address - City:COZAD
Practice Address - State:NE
Practice Address - Zip Code:69130-1609
Practice Address - Country:US
Practice Address - Phone:531-777-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH13679547374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide