Provider Demographics
NPI:1568793057
Name:KELLY, LAUREN A (NP)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:A
Last Name:KELLY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 DEVOE DR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1829
Mailing Address - Country:US
Mailing Address - Phone:414-405-6592
Mailing Address - Fax:
Practice Address - Street 1:8550 CUTHILLS CIR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9474
Practice Address - Country:US
Practice Address - Phone:402-476-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI153881363LA2200X
VA0024172608363LA2200X
NE112465363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1568793057Medicaid
WI1568793057Medicaid