Healthcare Provider Details

I. General information

NPI: 1083118491
Provider Name (Legal Business Name): CATHERINE KINGRY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2018
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 175TH ST
OMAHA NE
68118-3579
US

IV. Provider business mailing address

984455 NEBRASKA MEDICAL CTR
OMAHA NE
68198-4455
US

V. Phone/Fax

Practice location:
  • Phone: 402-596-4411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: