Healthcare Provider Details

I. General information

NPI: 1922955335
Provider Name (Legal Business Name): KELLI JO AUGUSTIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 2ND AVE
SHELBY NE
68662-5625
US

IV. Provider business mailing address

325 2ND AVE
SHELBY NE
68662-5625
US

V. Phone/Fax

Practice location:
  • Phone: 402-910-1303
  • Fax:
Mailing address:
  • Phone: 402-910-1303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberH12651012
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: