Provider Demographics
NPI:1487008090
Name:KATIE STURDEVANT, P.C.
Entity Type:Organization
Organization Name:KATIE STURDEVANT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN-BC
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:STURDEVANT
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:402-875-9270
Mailing Address - Street 1:3600 VILLAGE DRIVE, STE 110
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6621
Mailing Address - Country:US
Mailing Address - Phone:402-875-9270
Mailing Address - Fax:402-875-9272
Practice Address - Street 1:3600 VILLAGE DR STE 110
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6631
Practice Address - Country:US
Practice Address - Phone:402-875-9270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111649363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty