Active NPI
Kristy Lynn Mixan
- Counselor
- Omaha, NE
National Provider Identifier
1104965896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 1422
- Practice address
- 425 N 30TH St
Omaha, NE 68131-2100 - Phone
- (402) 452-5000
- Fax
- (402) 452-5028
- NPI assigned
- Feb 6, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 1422 | NE | Primary |
Addresses
Primary practice location
425 N 30TH St
Omaha, NE 68131-2100
Mailing address
555 N 30TH St
Omaha, NE 68131-2136
Phone (402) 280-8100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84366 | Other | NE | BCBS BT |
| 84445 | Other | NE | BCBS ENT |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1422 | NE | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1290384000000",
"number": "1104965896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 N 30TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681312136",
"telephone_number": "402-280-8100",
"fax_number": "402-280-8103"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 N 30TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681312100",
"telephone_number": "402-452-5000",
"fax_number": "402-452-5028"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIXAN",
"first_name": "KRISTY",
"middle_name": "LYNN",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-06",
"last_updated": "2010-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NE",
"license": "1422",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS BT",
"identifier": "84366",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS ENT",
"identifier": "84445",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.