Provider Demographics
NPI:1275528200
Name:OSSENKOP, KELLI CHRISTINE (PAC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:CHRISTINE
Last Name:OSSENKOP
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6825 S 27TH ST
Mailing Address - Street 2:STE 201
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-4872
Mailing Address - Country:US
Mailing Address - Phone:402-434-5235
Mailing Address - Fax:402-489-2137
Practice Address - Street 1:2900 S 70TH ST
Practice Address - Street 2:STE 310
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-3688
Practice Address - Country:US
Practice Address - Phone:402-434-5235
Practice Address - Fax:402-484-8891
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NENE809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47055126013Medicaid
NE47055126013Medicaid
278161Medicare ID - Type Unspecified