Provider Demographics
NPI:1477841898
Name:KRATOCHVIL, NICOLE CATHERINE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:CATHERINE
Last Name:KRATOCHVIL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:NICOLE
Other - Middle Name:CATHERINE
Other - Last Name:KEISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:812 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:BLAIR
Mailing Address - State:NE
Mailing Address - Zip Code:68008-1128
Mailing Address - Country:US
Mailing Address - Phone:402-426-4611
Mailing Address - Fax:402-426-4642
Practice Address - Street 1:812 N 22ND ST
Practice Address - Street 2:
Practice Address - City:BLAIR
Practice Address - State:NE
Practice Address - Zip Code:68008-1128
Practice Address - Country:US
Practice Address - Phone:402-426-4611
Practice Address - Fax:402-426-4642
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4901363AM0700X
NE2099363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE2099OtherNE STATE LICENSE
AZ4901OtherAZ STATE PA LICENSE