Provider Demographics
NPI:1043978471
Name:KERR, NICOLE (MA, ATC, NSCA-CPT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:KERR
Suffix:
Gender:F
Credentials:MA, ATC, NSCA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15722 SHAMROCK RD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68118-2172
Mailing Address - Country:US
Mailing Address - Phone:402-630-3656
Mailing Address - Fax:
Practice Address - Street 1:7700 S 43RD ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:NE
Practice Address - Zip Code:68147-1706
Practice Address - Country:US
Practice Address - Phone:402-734-2000
Practice Address - Fax:402-734-4270
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5262255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer