Provider Demographics
NPI:1194474874
Name:WORKMAN, KELLIE
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:
Last Name:WORKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:NE
Mailing Address - Zip Code:68376-6111
Mailing Address - Country:US
Mailing Address - Phone:402-862-2235
Mailing Address - Fax:402-862-3135
Practice Address - Street 1:810 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:NE
Practice Address - Zip Code:68376-6111
Practice Address - Country:US
Practice Address - Phone:402-862-2235
Practice Address - Fax:402-862-3135
Is Sole Proprietor?:No
Enumeration Date:2022-03-21
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool