Provider Demographics
NPI:1063953453
Name:BAXA, KELSEY LYNN (NP)
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:BAXA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:PAPILLION
Mailing Address - State:NE
Mailing Address - Zip Code:68046-5706
Mailing Address - Country:US
Mailing Address - Phone:402-593-3141
Mailing Address - Fax:402-593-3145
Practice Address - Street 1:1520 S 70TH ST STE 200
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506
Practice Address - Country:US
Practice Address - Phone:402-464-9000
Practice Address - Fax:402-464-4447
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112192363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE112192OtherNE MEDICAL LICENSE