Provider Demographics
NPI:1093218083
Name:PUCKETT, SUSAN KAY (RN)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-5331
Mailing Address - Country:US
Mailing Address - Phone:308-698-8000
Mailing Address - Fax:
Practice Address - Street 1:320 W 24TH ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845-5331
Practice Address - Country:US
Practice Address - Phone:308-698-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE52227163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool