Larson, Kellie D
Larson, Kellie D is an individual health care provider with primary practice located at 8201 Northwoods Dr , Lincoln NE 68505-3092. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Medical, which is considered as her primary health care specialty. Larson, Kellie D can be contacted via phone (402) 465-5600.Contact Information
Primary practice address
8201 Northwoods Dr
Lincoln NE 68505-3092
Phone: (402) 465-5600
Fax: (402) 327-6017
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | 737 | Nebraska |
Profile Details
| NPI number | 1962489914 |
|---|---|
| LBN Legal business name | Larson, Kellie D |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 29th, 2005 |
| Last updated | Mar 6th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1962489914 | NPPES |
| Nebraska | MEDICAID | 10025151600 | |
| Nebraska | MEDICAID | 47079049100 | |
| Nebraska | MEDICAID | 10026368300 | |
| Nebraska | MEDICAID | 47079049112 |
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