Provider Demographics
NPI:1396218996
Name:FITCH, KYLEE SUE (APRN)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:SUE
Last Name:FITCH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KYLEE
Other - Middle Name:SUE
Other - Last Name:DOUGLAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4545 R ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-3799
Mailing Address - Country:US
Mailing Address - Phone:402-465-4545
Mailing Address - Fax:402-465-9011
Practice Address - Street 1:4545 R ST STE 100
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68503-3799
Practice Address - Country:US
Practice Address - Phone:402-465-4545
Practice Address - Fax:402-465-9011
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112686363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE112686OtherAPRN LICENSE