Provider Demographics
NPI:1124527288
Name:SALCEDO, KALYNN (PA-C)
Entity type:Individual
Prefix:
First Name:KALYNN
Middle Name:
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8007 S 188TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1664
Mailing Address - Country:US
Mailing Address - Phone:402-649-6494
Mailing Address - Fax:
Practice Address - Street 1:7831 CHICAGO CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3654
Practice Address - Country:US
Practice Address - Phone:402-354-1230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-05
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant