Provider Demographics
NPI:1245629815
Name:DAUGHERTY, KELSEY LYNN (DNP, RN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:DNP, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7636 S 78TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-4023
Mailing Address - Country:US
Mailing Address - Phone:816-666-4201
Mailing Address - Fax:
Practice Address - Street 1:7636 S 78TH ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4023
Practice Address - Country:US
Practice Address - Phone:816-666-4201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-20
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-76665-061363LP0808X
KS13-119579-061163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201243690AMedicaid