Provider Demographics
NPI:1417045733
Name:PRITCHETT, KELLY LYNN (AUD)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:LYNN
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:LYNN
Other - Last Name:WACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:203A BARKLEY MEMORIAL CENTER
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68583-0731
Mailing Address - Country:US
Mailing Address - Phone:402-472-8824
Mailing Address - Fax:402-472-3814
Practice Address - Street 1:203A BARKLEY MEMORIAL CENTER
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68583-0731
Practice Address - Country:US
Practice Address - Phone:402-472-8824
Practice Address - Fax:402-472-3814
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE689237600000X
NE076237600000X
NE222231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE37041OtherBCBS
NE222OtherNE AUDIOLOGY LICENSE
NE10025369400Medicaid
NE689OtherNE LICENSE HEARING AID DI
NE10025369300Medicaid
IL147001173OtherLICENSE
P00453085OtherMEDICARE-RAILROAD
NE281221Medicare PIN