Healthcare Provider Details

I. General information

NPI: 1689244824
Provider Name (Legal Business Name): KYLEE MARIE LIENEMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 22ND AVE
KEARNEY NE
68845-2234
US

IV. Provider business mailing address

4406 SUNSET TRL
KEARNEY NE
68845-2364
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2263
  • Fax:
Mailing address:
  • Phone: 308-529-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number113803
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: