Healthcare Provider Details

I. General information

NPI: 1538277546
Provider Name (Legal Business Name): KIMBERLY K KUDRON MPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 70TH ST RM 2504
LINCOLN NE
68510-2462
US

IV. Provider business mailing address

8055 O ST STE 300
LINCOLN NE
68510-2580
US

V. Phone/Fax

Practice location:
  • Phone: 402-219-7498
  • Fax:
Mailing address:
  • Phone: 402-421-0896
  • Fax: 402-421-0945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number1342
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: