Provider Demographics
NPI:1538482690
Name:PLATEK, KELLI A (PAC)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:A
Last Name:PLATEK
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 406
Mailing Address - Street 2:1113 SHERMAN STREET
Mailing Address - City:SAINT PAUL
Mailing Address - State:NE
Mailing Address - Zip Code:68873-0406
Mailing Address - Country:US
Mailing Address - Phone:308-754-5447
Mailing Address - Fax:308-754-5449
Practice Address - Street 1:1113 SHERMAN STREET
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:NE
Practice Address - Zip Code:68873-0406
Practice Address - Country:US
Practice Address - Phone:308-754-5447
Practice Address - Fax:308-754-5449
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1502363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant