Healthcare Provider Details

I. General information

NPI: 1245036698
Provider Name (Legal Business Name): TARYN AUBREE WIEKHORST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E 17TH ST
SCOTTSBLUFF NE
69361-3270
US

IV. Provider business mailing address

PO BOX 1327
SCOTTSBLUFF NE
69363-1327
US

V. Phone/Fax

Practice location:
  • Phone: 308-632-8776
  • Fax:
Mailing address:
  • Phone: 308-632-8016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: