Healthcare Provider Details

I. General information

NPI: 1255915682
Provider Name (Legal Business Name): MARKIE KIDD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2021
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 S 13TH ST STE 1111
LINCOLN NE
68508-2003
US

IV. Provider business mailing address

4331 LEAVENWORTH ST
OMAHA NE
68105-1031
US

V. Phone/Fax

Practice location:
  • Phone: 323-522-2218
  • Fax:
Mailing address:
  • Phone: 806-681-3102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number26R503
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number162974
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1577
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: