Healthcare Provider Details

I. General information

NPI: 1669358362
Provider Name (Legal Business Name): LUCAS CHAMBERLAIN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 SOUTH ST
LINCOLN NE
68502-2467
US

IV. Provider business mailing address

PO BOX 5155
LINCOLN NE
68505-0155
US

V. Phone/Fax

Practice location:
  • Phone: 402-841-4720
  • Fax: 402-252-7873
Mailing address:
  • Phone: 402-841-4720
  • Fax: 402-252-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number116247
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: