Healthcare Provider Details

I. General information

NPI: 1699680728
Provider Name (Legal Business Name): BRENDA TRACY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 SUNFLOWER DR
HICKMAN NE
68372-9812
US

IV. Provider business mailing address

720 SUNFLOWER DR
HICKMAN NE
68372-9812
US

V. Phone/Fax

Practice location:
  • Phone: 402-416-3328
  • Fax:
Mailing address:
  • Phone: 402-416-3328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: