1801064878 NPI number — KAYLA M DICKE P.A.-C.

Table of content: KAYLA M DICKE P.A.-C. (NPI 1801064878)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801064878 NPI number — KAYLA M DICKE P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKE
Provider First Name:
KAYLA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KAPELS
Provider Other First Name:
KAYLA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
P.A.-C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1801064878
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4508 38TH ST
Provider Second Line Business Mailing Address:
SUITE #152
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68601-1668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-563-4500
Provider Business Mailing Address Fax Number:
402-563-3520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4508 38TH ST
Provider Second Line Business Practice Location Address:
SUITE #152
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68601-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-563-4500
Provider Business Practice Location Address Fax Number:
402-563-3520
Provider Enumeration Date:
02/13/2008

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: 363AS0400X , with the licence number:  1377 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Y00000X , with the licence number: 1377 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10025979300 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 37454 . This is a "BLUE CROSS OF NEBRASKA" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 1538141593 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 061181648-68601-A004 . This is a "TRIWEST" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 255449 . This is a "MIDLANDS CHOICE PPO" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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