MEDICARE: MS. KIM E. MCGHEE

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	164W00000X	Licensed Practical Nurse	16850	NE

General Provider Information

NPI Number	:	1659174894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIM E. MCGHEE

Provider Business Mailing Address
First Line	:	4542 LARIMORE AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-2448
Country	:	US
Telephone Number	:	402-320-6445
Fax Number	:

Provider Business Practice Location Address
First Line	:	4542 LARIMORE AVE
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68104-2448
Country	:	US
Telephone Number	:	402-320-6445
Fax Number	:

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

Provider Enumeration Date	:	03/31/2025
Last Update Date	:	03/31/2025

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