1760568067 NPI number — MS. JEANIE ZINK-WYTHERS MA, LMHP, LADC

Table of content: (NPI 1780635342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760568067 NPI number — MS. JEANIE ZINK-WYTHERS MA, LMHP, LADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZINK-WYTHERS
Provider First Name:
JEANIE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMHP, LADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760568067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 ROAD I
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRMONT
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68354-4049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-759-2285
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1320 G ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GENEVA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68361-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-759-2285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2006

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: 101YA0400X , with the licence number:  254 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 736 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 565 , 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: 62-89529 . This is a "UNITED HEALTHCARE SERVICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 100251239-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8355 . This is a "MIDLANDS CHOICE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 85194 . This is a "BCBS" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 187876 . This is a "MAGELLAN HEALTH SERVICES" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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