Healthcare Provider Details

I. General information

NPI: 1770564759
Provider Name (Legal Business Name): KATHRYN JANICE LEEPER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 S 58TH ST SUITE W
LINCOLN NE
68516-6402
US

IV. Provider business mailing address

5930 S 58TH ST SUITE W
LINCOLN NE
68516-6402
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-6402
  • Fax: 402-423-6422
Mailing address:
  • Phone: 402-423-6402
  • Fax: 402-423-6422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number18698
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: