Provider Demographics
NPI:1144308420
Name:GWARTNEY, KELLY RENEE (MA PLMHP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:RENEE
Last Name:GWARTNEY
Suffix:
Gender:F
Credentials:MA PLMHP
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:RENEE
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8140 S CHERRYWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510
Mailing Address - Country:US
Mailing Address - Phone:402-327-8208
Mailing Address - Fax:
Practice Address - Street 1:1903 4TH CORSO
Practice Address - Street 2:
Practice Address - City:NEBRASKA
Practice Address - State:NE
Practice Address - Zip Code:68410-2601
Practice Address - Country:US
Practice Address - Phone:402-873-5505
Practice Address - Fax:402-873-6374
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE7827101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052851501Medicaid
NE10025208500Medicaid