Healthcare Provider Details

I. General information

NPI: 1104944867
Provider Name (Legal Business Name): DARRELL LYNN KEITH PLMHP, PAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 10TH ST
GERING NE
69341-2412
US

IV. Provider business mailing address

1720 10TH ST
GERING NE
69341-2412
US

V. Phone/Fax

Practice location:
  • Phone: 308-436-3817
  • Fax: 308-436-4718
Mailing address:
  • Phone: 308-436-3817
  • Fax: 308-436-4718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8232
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: