Provider Demographics
NPI:1619740990
Name:PLESKAC, KELLIE LYNN (LPN)
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:LYNN
Last Name:PLESKAC
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLER
Mailing Address - State:NE
Mailing Address - Zip Code:68661-2016
Mailing Address - Country:US
Mailing Address - Phone:402-352-5514
Mailing Address - Fax:402-352-2644
Practice Address - Street 1:200 W 10TH ST
Practice Address - Street 2:
Practice Address - City:SCHUYLER
Practice Address - State:NE
Practice Address - Zip Code:68661-2016
Practice Address - Country:US
Practice Address - Phone:402-352-5514
Practice Address - Fax:402-352-2644
Is Sole Proprietor?:No
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25886164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse