Healthcare Provider Details

I. General information

NPI: 1306790456
Provider Name (Legal Business Name): MCKAYLA THERKILDSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2026
Last Update Date: 02/25/2026
Certification Date: 02/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 SOUTH ST
LINCOLN NE
68502-2467
US

IV. Provider business mailing address

1430 SOUTH ST
LINCOLN NE
68502-2467
US

V. Phone/Fax

Practice location:
  • Phone: 308-520-3462
  • Fax: 308-520-3462
Mailing address:
  • Phone: 308-520-3462
  • Fax: 308-520-3462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: