Provider Demographics
NPI:1982673331
Name:COUGHLIN, NEIKA L (APRN C)
Entity Type:Individual
Prefix:
First Name:NEIKA
Middle Name:L
Last Name:COUGHLIN
Suffix:
Gender:F
Credentials:APRN C
Other - Prefix:
Other - First Name:NEIKA
Other - Middle Name:L
Other - Last Name:PROFFITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3755
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68103-0755
Mailing Address - Country:US
Mailing Address - Phone:402-354-2100
Mailing Address - Fax:402-354-6171
Practice Address - Street 1:1120 N 103RD PLZ
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-1114
Practice Address - Country:US
Practice Address - Phone:402-391-5055
Practice Address - Fax:402-391-5053
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110645363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100264481-00Medicaid
IA1982673331Medicaid
IA1982673331Medicaid