Healthcare Provider Details

I. General information

NPI: 1417045733
Provider Name (Legal Business Name): KELLY LYNN PRITCHETT AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY LYNN WACKER AUD

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203A BARKLEY MEMORIAL CENTER
LINCOLN NE
68583-0731
US

IV. Provider business mailing address

203A BARKLEY MEMORIAL CENTER
LINCOLN NE
68583-0731
US

V. Phone/Fax

Practice location:
  • Phone: 402-472-8824
  • Fax: 402-472-3814
Mailing address:
  • Phone: 402-472-8824
  • Fax: 402-472-3814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number689
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number076
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number222
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: