Healthcare Provider Details

I. General information

NPI: 1437498474
Provider Name (Legal Business Name): KELSEY N WERGIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2013
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7121 STEPHANIE LN STE 102
LINCOLN NE
68516-5352
US

IV. Provider business mailing address

7121 STEPHANIE LN STE 102
LINCOLN NE
68516-5352
US

V. Phone/Fax

Practice location:
  • Phone: 402-413-5010
  • Fax:
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-342-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number1718
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: