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General NPI Number Information
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NPI Number | 1740865914
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Entity Type | Individual
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Provider Name | STACY KELLUM FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/10/2021
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 233 S 13TH ST STE 1100
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City | LINCOLN
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State | NE
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Zip | 68508-2003
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Country | US
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Telephone | 720-897-3749
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Fax |
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Provider Business Mailing Address
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Address Line | 527 N 5TH ST
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City | ONEILL
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State | NE
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Zip | 68763-1327
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Country | US
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Telephone | 402-540-1804
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 113220
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License Number State | NE
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