Healthcare Provider Details

I. General information

NPI: 1154934859
Provider Name (Legal Business Name): KATHY J CARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 26
BASSETT NE
68714-0026
US

IV. Provider business mailing address

PO BOX 26
BASSETT NE
68714-0026
US

V. Phone/Fax

Practice location:
  • Phone: 402-684-2908
  • Fax: 402-913-3454
Mailing address:
  • Phone: 402-684-2908
  • Fax: 402-913-3454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12654
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: