Provider Demographics
NPI:1639437866
Name:FENTON, KARI LYN (PLMHP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:LYN
Last Name:FENTON
Suffix:
Gender:F
Credentials:PLMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3752
Mailing Address - Country:US
Mailing Address - Phone:402-686-7648
Mailing Address - Fax:
Practice Address - Street 1:14301 FIRST NATIONAL BANK PKWY
Practice Address - Street 2:SUITE 124
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-7200
Practice Address - Country:US
Practice Address - Phone:402-686-7648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health