Provider Demographics
NPI:1477359081
Name:KRANTZ, KODY JOSEPH (SERGEANT US ARMY)
Entity type:Individual
Prefix:
First Name:KODY
Middle Name:JOSEPH
Last Name:KRANTZ
Suffix:
Gender:
Credentials:SERGEANT US ARMY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 352
Mailing Address - Street 2:
Mailing Address - City:BAYARD
Mailing Address - State:NE
Mailing Address - Zip Code:69334-0352
Mailing Address - Country:US
Mailing Address - Phone:308-225-2012
Mailing Address - Fax:
Practice Address - Street 1:422 W 11TH ST
Practice Address - Street 2:
Practice Address - City:BAYARD
Practice Address - State:NE
Practice Address - Zip Code:69334-2044
Practice Address - Country:US
Practice Address - Phone:308-225-2012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEH13335198372600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion