Healthcare Provider Details

I. General information

NPI: 1952157968
Provider Name (Legal Business Name): T&K AESTHETICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1265 S COTNER BLVD STE 41D
LINCOLN NE
68510-4975
US

IV. Provider business mailing address

1265 S COTNER BLVD STE 41
LINCOLN NE
68510-4924
US

V. Phone/Fax

Practice location:
  • Phone: 402-219-4633
  • Fax: 531-248-4666
Mailing address:
  • Phone: 402-219-4633
  • Fax: 531-248-4666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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