Healthcare Provider Details

I. General information

NPI: 1801902408
Provider Name (Legal Business Name): KATHY JO CARTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 VILLAGE DR SUITE 150
LINCOLN NE
68516-6619
US

IV. Provider business mailing address

5421 QUAIL RIDGE CIR
LINCOLN NE
68516-1845
US

V. Phone/Fax

Practice location:
  • Phone: 402-423-1900
  • Fax: 402-423-5991
Mailing address:
  • Phone: 402-423-7265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110119
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: