MEDICARE: KELLY M HOUFEK APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	111568	NE
2	363LF0000X	Family Nurse Practitioner	111568	NE

General Provider Information

NPI Number	:	1417380486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY M HOUFEK APRN

Provider Business Mailing Address
First Line	:	4610 S 133RD ST STE 109
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1133
Country	:	US
Telephone Number	:	402-614-0010
Fax Number	:	402-614-0090

Provider Business Practice Location Address
First Line	:	4610 S 133RD ST STE 109
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68137-1133
Country	:	US
Telephone Number	:	402-614-0010
Fax Number	:	402-614-0090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2013
Last Update Date	:	03/02/2020

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