Healthcare Provider Details

I. General information

NPI: 1356143937
Provider Name (Legal Business Name): LYDIA ROSE KOKESH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD STE 100
OMAHA NE
68124-1900
US

IV. Provider business mailing address

1500 DOUGLAS AVE
YANKTON SD
57078-2244
US

V. Phone/Fax

Practice location:
  • Phone: 402-399-8888
  • Fax:
Mailing address:
  • Phone: 701-269-5586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberR056020
License Number StateSD
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR056020
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: