Healthcare Provider Details

I. General information

NPI: 1801980933
Provider Name (Legal Business Name): KATHRYN K. WHITE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHRYN K. ICKLER APRN

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 01/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 JAMES ST
VERDIGRE NE
68783-6149
US

IV. Provider business mailing address

PO BOX 99
VERDIGRE NE
68783-0099
US

V. Phone/Fax

Practice location:
  • Phone: 402-668-2216
  • Fax: 402-668-2310
Mailing address:
  • Phone: 402-668-2216
  • Fax: 402-668-2310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110334
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: