Provider Demographics
NPI:1144330457
Name:HAVLICEK, KATHY L (DNP, APRN-NP)
Entity type:Individual
Prefix:DR
First Name:KATHY
Middle Name:L
Last Name:HAVLICEK
Suffix:
Gender:F
Credentials:DNP, APRN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6831 SUMNER ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-1548
Mailing Address - Country:US
Mailing Address - Phone:402-525-1512
Mailing Address - Fax:402-488-6031
Practice Address - Street 1:7111 A ST STE 201
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-4283
Practice Address - Country:US
Practice Address - Phone:402-489-7100
Practice Address - Fax:402-489-3249
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110806363LP0808X, 363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE39194OtherBCBS - NHCP
NE252878OtherMIDLANDS - NHCP
NE10025595500OtherMEDICAID PIN
NE39194OtherBCBS - NHCP
281384Medicare PIN