Healthcare Provider Details

I. General information

NPI: 1952296501
Provider Name (Legal Business Name): KISHA PALMER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2025
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2707 L ST
ORD NE
68862-1275
US

IV. Provider business mailing address

508 HILLCREST DR
BROKEN BOW NE
68822-4302
US

V. Phone/Fax

Practice location:
  • Phone: 308-728-4355
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number76270
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: