Healthcare Provider Details

I. General information

NPI: 1831238088
Provider Name (Legal Business Name): NANCY A. PUCKETT LMHP, CPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N 15TH ST
ORD NE
68862-1458
US

IV. Provider business mailing address

PO BOX 226
ORD NE
68862-0226
US

V. Phone/Fax

Practice location:
  • Phone: 308-728-9979
  • Fax: 308-728-9980
Mailing address:
  • Phone: 308-728-9979
  • Fax: 308-728-9980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2947
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: