Healthcare Provider Details

I. General information

NPI: 1699253831
Provider Name (Legal Business Name): BRADLEY DAVID KUTSCHKAU APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 N 205TH ST
ELKHORN NE
68022-4885
US

IV. Provider business mailing address

7261 MERCY RD
OMAHA NE
68124-2311
US

V. Phone/Fax

Practice location:
  • Phone: 402-758-5464
  • Fax: 402-758-5398
Mailing address:
  • Phone: 402-758-5464
  • Fax: 402-758-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number112509
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: