Provider Demographics
NPI:1891970620
Name:THIEM, KENDRA A (PA-C)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:A
Last Name:THIEM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KENDRA
Other - Middle Name:A
Other - Last Name:SCHNIEDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2222 SOUTH 16TH STREET
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68502-3764
Mailing Address - Country:US
Mailing Address - Phone:402-323-7260
Mailing Address - Fax:402-323-7266
Practice Address - Street 1:2222 SOUTH 16TH STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68502-3764
Practice Address - Country:US
Practice Address - Phone:402-323-7260
Practice Address - Fax:402-323-7266
Is Sole Proprietor?:No
Enumeration Date:2007-12-28
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1354363A00000X
KS15-01367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200593630AMedicaid
NE39367OtherBCBS NE
NE255216OtherMIDLANDS CHOICE
KS200593630BMedicaid
P00634904OtherRRM
KS057379002Medicare PIN
NEP00634904Medicare PIN
KS200593630BMedicaid