=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043028251
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MCKAYLA JO DOBISH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2024
-----------------------------------------------------
Last Update Date | 12/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 812 N TYLER ST
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68850-2030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-293-5781
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 708 CENTRAL AVE
-----------------------------------------------------
City | EDDYVILLE
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68834-2505
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------