Provider Demographics
NPI:1255371886
Name:WILLCOCKSON, NANCY KRAUTER (PHD)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:KRAUTER
Last Name:WILLCOCKSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:KRAUTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11840 NICHOLAS ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4475
Mailing Address - Country:US
Mailing Address - Phone:402-932-7137
Mailing Address - Fax:402-932-7136
Practice Address - Street 1:11840 NICHOLAS ST
Practice Address - Street 2:SUITE 200
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4475
Practice Address - Country:US
Practice Address - Phone:402-932-7137
Practice Address - Fax:402-932-7136
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE241103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47037660467Medicaid
R29866Medicare UPIN
NE271452WIMedicare PIN
NE47037660467Medicaid
NE269905Medicare ID - Type Unspecified