Healthcare Provider Details

I. General information

NPI: 1174025340
Provider Name (Legal Business Name): KELLI ANN URBANEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 C AVE
KEARNEY NE
68847-6142
US

IV. Provider business mailing address

310 W 24TH ST
KEARNEY NE
68845-5331
US

V. Phone/Fax

Practice location:
  • Phone: 308-698-8190
  • Fax: 308-698-8192
Mailing address:
  • Phone: 308-698-8017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number48140
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: