Provider Demographics
NPI:1639814536
Name:YOUNG, KELLI A (CPSS)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:A
Last Name:YOUNG
Suffix:
Gender:F
Credentials:CPSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 LANDON CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-2414
Mailing Address - Country:US
Mailing Address - Phone:402-346-0902
Mailing Address - Fax:402-342-5290
Practice Address - Street 1:2240 LANDON CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68102-2414
Practice Address - Country:US
Practice Address - Phone:402-346-0902
Practice Address - Fax:402-342-5290
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NECPSS-154175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist