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General NPI Number Information
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NPI Number | 1477359081
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Entity Type | Individual
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Provider Name | KODY JOSEPH KRANTZ SERGEANT U.S. ARMY
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Gender | Male
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 422 W 11TH ST
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City | BAYARD
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State | NE
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Zip | 69334-2044
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Country | US
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Telephone | 308-225-2012
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 352
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City | BAYARD
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State | NE
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Zip | 69334-0352
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Country | US
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Telephone | 308-225-2012
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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 | 372600000X
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Taxonomy Name | Adult Companion
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License Number | H13335198
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License Number State | NE
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