Healthcare Provider Details

I. General information

NPI: 1790628931
Provider Name (Legal Business Name): RACHEL KAYE KELLOGG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

IV. Provider business mailing address

2501 CAPEHART RD
OFFUTT AFB NE
68113-1043
US

V. Phone/Fax

Practice location:
  • Phone: 402-294-3212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS-10526
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: