Provider Demographics
NPI:1871092353
Name:STALLINGS, JANETTE ELAINE THOMAS (APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JANETTE
Middle Name:ELAINE THOMAS
Last Name:STALLINGS
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1420
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-1420
Mailing Address - Country:US
Mailing Address - Phone:402-502-1931
Mailing Address - Fax:402-999-4812
Practice Address - Street 1:1620 WILSHIRE DR STE 222
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68005-6600
Practice Address - Country:US
Practice Address - Phone:402-502-1931
Practice Address - Fax:402-999-4812
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-09
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE16900Medicaid