MEDICARE: KIMBERLY JO MADDOCKS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	372500000X	Chore Provider	NE
2	372600000X	Adult Companion	NE
3	3747P1801X	Personal Care Attendant	NE

General Provider Information

NPI Number	:	1619859444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY JO MADDOCKS

Provider Business Mailing Address
First Line	:	990 WALNUT ST
Second Line	:
City	:	SYRACUSE
State	:	NE
Zip	:	68446-9698
Country	:	US
Telephone Number	:	402-613-8192
Fax Number	:

Provider Business Practice Location Address
First Line	:	990 WALNUT ST
Second Line	:
City	:	SYRACUSE
State	:	NE
Zip	:	68446-9698
Country	:	US
Telephone Number	:	402-613-8192
Fax Number	:

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

Provider Enumeration Date	:	07/23/2025
Last Update Date	:	07/23/2025

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Directions to “ KIMBERLY JO MADDOCKS ” Practice Location

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