Provider Demographics
NPI:1417380486
Name:HOUFEK, KELLY M (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:HOUFEK
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:M
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4610 S 133RD ST STE 109
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1133
Mailing Address - Country:US
Mailing Address - Phone:402-614-0010
Mailing Address - Fax:402-614-0090
Practice Address - Street 1:4610 S 133RD ST STE 109
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-1133
Practice Address - Country:US
Practice Address - Phone:402-614-0010
Practice Address - Fax:402-614-0090
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111568363LP0808X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily