Healthcare Provider Details

I. General information

NPI: 1558047209
Provider Name (Legal Business Name): MARY KATHRYN MCLAUGHLIN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 TIGER LILY RD STE 100
LINCOLN NE
68516-5587
US

IV. Provider business mailing address

4101 TIGER LILY RD STE 100
LINCOLN NE
68516-5587
US

V. Phone/Fax

Practice location:
  • Phone: 402-420-7000
  • Fax: 402-420-6969
Mailing address:
  • Phone: 402-420-7000
  • Fax: 402-420-6969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3217
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: