Healthcare Provider Details

I. General information

NPI: 1659295244
Provider Name (Legal Business Name): KILE M WILHITE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7614 PONCE DR
LINCOLN NE
68516-4419
US

IV. Provider business mailing address

7614 PONCE DR
LINCOLN NE
68516-4419
US

V. Phone/Fax

Practice location:
  • Phone: 402-617-0830
  • Fax:
Mailing address:
  • Phone: 402-617-0830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: