Provider Demographics
NPI:1790420628
Name:ZIMMERMAN, MYKELTIE R
Entity Type:Individual
Prefix:MRS
First Name:MYKELTIE
Middle Name:R
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:MYKELTIE
Other - Middle Name:R
Other - Last Name:MEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:819 N DIERS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4957
Mailing Address - Country:US
Mailing Address - Phone:308-395-8107
Mailing Address - Fax:
Practice Address - Street 1:819 N DIERS AVE STE 1
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4957
Practice Address - Country:US
Practice Address - Phone:308-395-8107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist