Provider Demographics
NPI:1003517335
Name:TANDY, KIMBERLEE (MME, MT-BC)
Entity Type:Individual
Prefix:
First Name:KIMBERLEE
Middle Name:
Last Name:TANDY
Suffix:
Gender:F
Credentials:MME, MT-BC
Other - Prefix:
Other - First Name:KIMBERLEE
Other - Middle Name:
Other - Last Name:WATNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MME, MT-BC
Mailing Address - Street 1:822 N LINCOLN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:NE
Mailing Address - Zip Code:68467-2444
Mailing Address - Country:US
Mailing Address - Phone:402-366-2017
Mailing Address - Fax:
Practice Address - Street 1:822 N LINCOLN AVE STE A
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:NE
Practice Address - Zip Code:68467-2444
Practice Address - Country:US
Practice Address - Phone:402-366-1296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-14
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS07076225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist