Active NPI
Kristi Lynne Tackett-Newburg, PHD LIMHP CPC
- Professional Counselor
- Omaha, NE
National Provider Identifier
1609082189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 293
- Practice address
- 9802 Nicholas St Ste 350
Omaha, NE 68114-2106 - Phone
- (402) 932-2296
- Fax
- (402) 281-0665
- NPI assigned
- May 14, 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 |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 293 | NE | Primary |
Addresses
Primary practice location
9802 Nicholas St Ste 350
Omaha, NE 68114-2106
Mailing address
9802 Nicholas St Ste 350
Omaha, NE 68114-2106
Phone (402) 932-2296
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 10025043400 | Medicaid | NE |
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
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 293 | NE | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606780800000",
"number": "1609082189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9802 NICHOLAS ST STE 350",
"city": "OMAHA",
"state": "NE",
"postal_code": "681142106",
"telephone_number": "402-932-2296",
"fax_number": "402-281-0665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9802 NICHOLAS ST STE 350",
"city": "OMAHA",
"state": "NE",
"postal_code": "681142106",
"telephone_number": "402-932-2296",
"fax_number": "402-281-0665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TACKETT-NEWBURG",
"first_name": "KRISTI",
"middle_name": "LYNNE",
"credential": "PHD LIMHP CPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-14",
"last_updated": "2020-12-01",
"certification_date": "2020-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NE",
"license": "293",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "10025043400",
"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 Dec 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.