Healthcare Provider Details

I. General information

NPI: 1184421000
Provider Name (Legal Business Name): FATU KEKULA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 BURR ST
LINCOLN NE
68502-3916
US

IV. Provider business mailing address

220 OAKCREEK DR # NE68528
LINCOLN NE
68528-1587
US

V. Phone/Fax

Practice location:
  • Phone: 402-817-4959
  • Fax:
Mailing address:
  • Phone: 402-817-4959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: