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General NPI Number Information
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NPI Number | 1164974747
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Entity Type | Individual
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Provider Name | KATIE KYKER PMHP
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Gender | Female
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Dates
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Enumeration Date | 10/28/2016
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Last Update Date | 12/21/2016
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Provider Practice Location Address
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Address Line | 1627 E MILITARY AVE
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City | FREMONT
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State | NE
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Zip | 68025-5490
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Country | US
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Telephone | 402-727-4886
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Fax |
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Provider Business Mailing Address
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Address Line | 1627 E MILITARY AVE
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City | FREMONT
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State | NE
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Zip | 68025-5490
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 11031
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License Number State | NE
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 7111
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 2898
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License Number State | NE
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