Healthcare Provider Details

I. General information

NPI: 1275220949
Provider Name (Legal Business Name): KATECARES TELEMEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2023
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5309 NW 3RD ST
LINCOLN NE
68521-5301
US

IV. Provider business mailing address

5309 NW 3RD ST
LINCOLN NE
68521-5301
US

V. Phone/Fax

Practice location:
  • Phone: 402-219-4633
  • Fax:
Mailing address:
  • Phone: 402-219-4633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATIEVIA RUSH-WILKS
Title or Position: OWNER/NP
Credential: NP
Phone: 402-219-4633