Healthcare Provider Details

I. General information

NPI: 1821918392
Provider Name (Legal Business Name): MINDY LIVELY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 12TH AVE
SCOTTSBLUFF NE
69361-4525
US

IV. Provider business mailing address

3501 12TH AVE
SCOTTSBLUFF NE
69361-4525
US

V. Phone/Fax

Practice location:
  • Phone: 308-430-3132
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: