Healthcare Provider Details

I. General information

NPI: 1144308420
Provider Name (Legal Business Name): KELLY RENEE GWARTNEY MA PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY RENEE CHRISTENSEN

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1903 4TH CORSO
NEBRASKA NE
68410-2601
US

IV. Provider business mailing address

8140 S CHERRYWOOD DRIVE
LINCOLN NE
68510
US

V. Phone/Fax

Practice location:
  • Phone: 402-873-5505
  • Fax: 402-873-6374
Mailing address:
  • Phone: 402-327-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number7827
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: