Provider Demographics
NPI:1275999500
Name:KEMP, NICOLE RAE (RDA)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:RAE
Last Name:KEMP
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 E DOUGLAS ST.
Mailing Address - Street 2:
Mailing Address - City:O'NEILL
Mailing Address - State:NE
Mailing Address - Zip Code:68763
Mailing Address - Country:US
Mailing Address - Phone:402-336-2406
Mailing Address - Fax:402-336-1768
Practice Address - Street 1:422 E DOUGLAS ST.
Practice Address - Street 2:
Practice Address - City:O'NEILL
Practice Address - State:NE
Practice Address - Zip Code:68763
Practice Address - Country:US
Practice Address - Phone:402-336-2406
Practice Address - Fax:402-336-1768
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare