1417045733 NPI number — MS. KELLY LYNN PRITCHETT AUD

Table of content: LAKESHA BLASH (NPI 1659147643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417045733 NPI number — MS. KELLY LYNN PRITCHETT AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRITCHETT
Provider First Name:
KELLY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
AUD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WACKER
Provider Other First Name:
KELLY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417045733
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/30/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
203A BARKLEY MEMORIAL CENTER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68583-0731
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-472-8824
Provider Business Mailing Address Fax Number:
402-472-3814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203A BARKLEY MEMORIAL CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68583-0731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-472-8824
Provider Business Practice Location Address Fax Number:
402-472-3814
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237600000X , with the licence number:  689 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 076 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 222 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 37041 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 222 . This is a "NE AUDIOLOGY LICENSE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025369400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 689 . This is a "NE LICENSE HEARING AID DI" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 10025369300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 147001173 . This is a "LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: P00453085 . This is a "MEDICARE-RAILROAD" identifier . This identifiers is of the category "OTHER".




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