Provider Demographics
NPI:1710054937
Name:PLACKE, PENNY KAY (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PENNY
Middle Name:KAY
Last Name:PLACKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 W ROCK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:NE
Mailing Address - Zip Code:68065-8719
Mailing Address - Country:US
Mailing Address - Phone:402-433-2419
Mailing Address - Fax:
Practice Address - Street 1:1101 S 70TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4293
Practice Address - Country:US
Practice Address - Phone:402-488-1400
Practice Address - Fax:402-488-3215
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE837363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE75306398600Medicaid
NE278188Medicare ID - Type Unspecified