Healthcare Provider Details

I. General information

NPI: 1144330457
Provider Name (Legal Business Name): KATHY L. HAVLICEK DNP, APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 05/02/2021
Certification Date: 05/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 A ST STE 201
LINCOLN NE
68510-4283
US

IV. Provider business mailing address

6831 SUMNER ST
LINCOLN NE
68506-1548
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-7100
  • Fax: 402-489-3249
Mailing address:
  • Phone: 402-525-1512
  • Fax: 402-488-6031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number110806
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number110806
License Number StateNE
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number110806
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: