Healthcare Provider Details

I. General information

NPI: 1821853037
Provider Name (Legal Business Name): WATERFIELD HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2024
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 W 18TH ST
KEARNEY NE
68845-5944
US

IV. Provider business mailing address

PO BOX 1003
KEARNEY NE
68848-1003
US

V. Phone/Fax

Practice location:
  • Phone: 308-251-1913
  • Fax: 949-695-4142
Mailing address:
  • Phone: 308-251-1913
  • Fax: 949-695-4142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DENISE WATERFIELD
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: NP
Phone: 308-251-1913