Provider Demographics
NPI:1336022326
Name:KELLER-JACKET, KRYSTALL MARIE ELIZABETH
Entity type:Individual
Prefix:
First Name:KRYSTALL
Middle Name:MARIE ELIZABETH
Last Name:KELLER-JACKET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7705 NINA ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68124-4030
Mailing Address - Country:US
Mailing Address - Phone:402-982-3372
Mailing Address - Fax:
Practice Address - Street 1:7705 NINA ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-4030
Practice Address - Country:US
Practice Address - Phone:402-982-3372
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE67197376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide