Provider Demographics
NPI:1013908656
Name:KENNEL, MELINDA KATHRYN (OD)
Entity Type:Individual
Prefix:DR
First Name:MELINDA
Middle Name:KATHRYN
Last Name:KENNEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 S 13TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5733
Mailing Address - Country:US
Mailing Address - Phone:402-379-1434
Mailing Address - Fax:402-371-9154
Practice Address - Street 1:1130 S 13TH ST STE 200
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-5733
Practice Address - Country:US
Practice Address - Phone:402-379-1434
Practice Address - Fax:402-374-9154
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1728152W00000X
NE1190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS651110OtherBCBS
NENA1061002OtherMEDICARE PTAN
KS200383330AMedicaid
KS651109OtherBCBS
KS200383330BMedicaid
NE36700OtherBCBS
NESSN00Medicaid
KS200383330AMedicaid
NE36700OtherBCBS
KSV09684Medicare UPIN