Provider Demographics
NPI:1578113130
Name:BARBARA K CLINKENBEARD PC
Entity Type:Organization
Organization Name:BARBARA K CLINKENBEARD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLINKEMBEARD
Authorized Official - Suffix:
Authorized Official - Credentials:PC
Authorized Official - Phone:402-953-9610
Mailing Address - Street 1:13911 GOLD CIR STE 210
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68144-2376
Mailing Address - Country:US
Mailing Address - Phone:402-333-6950
Mailing Address - Fax:402-333-6944
Practice Address - Street 1:13911 GOLD CIR STE 210
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-2376
Practice Address - Country:US
Practice Address - Phone:402-333-6950
Practice Address - Fax:402-333-6944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026806600Medicaid