Provider Demographics
NPI:1821465881
Name:KASPERBAUER, MACY LEE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:MACY
Middle Name:LEE
Last Name:KASPERBAUER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20324 VETERANS DR STE 104
Mailing Address - Street 2:
Mailing Address - City:ELKHORN
Mailing Address - State:NE
Mailing Address - Zip Code:68022-3552
Mailing Address - Country:US
Mailing Address - Phone:402-933-5700
Mailing Address - Fax:402-933-9998
Practice Address - Street 1:20324 VETERANS DR STE 104
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:NE
Practice Address - Zip Code:68022-3552
Practice Address - Country:US
Practice Address - Phone:402-933-5700
Practice Address - Fax:402-933-9998
Is Sole Proprietor?:No
Enumeration Date:2015-08-26
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE111887363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE$$$$$$$$$OtherMEDICAID