Healthcare Provider Details

I. General information

NPI: 1063355972
Provider Name (Legal Business Name): KELLY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N 4TH ST STE 108
ONEILL NE
68763-1317
US

IV. Provider business mailing address

717 E DONEGAL ST
ONEILL NE
68763-1133
US

V. Phone/Fax

Practice location:
  • Phone: 402-336-1306
  • Fax: 402-336-1246
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: