Provider Demographics
NPI:1932118908
Name:MEYER, KATHY D (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:D
Last Name:MEYER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:GRANT
Mailing Address - State:NE
Mailing Address - Zip Code:69140-3099
Mailing Address - Country:US
Mailing Address - Phone:308-352-7100
Mailing Address - Fax:308-352-7290
Practice Address - Street 1:912 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:GRANT
Practice Address - State:NE
Practice Address - Zip Code:69140-3099
Practice Address - Country:US
Practice Address - Phone:308-352-7100
Practice Address - Fax:308-352-7290
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE086001001Medicare PIN
NES27624Medicare UPIN
COS27624Medicare UPIN