Provider Demographics
NPI:1871863621
Name:GEWEKE, KELLY ANN (APRN)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:GEWEKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2707 L ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1275
Mailing Address - Country:US
Mailing Address - Phone:308-728-4202
Mailing Address - Fax:308-728-3500
Practice Address - Street 1:2707 L ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1275
Practice Address - Country:US
Practice Address - Phone:308-728-4202
Practice Address - Fax:308-728-3500
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2016-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE111324363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE111324OtherSTATE OF NEBRASKA