Provider Demographics
NPI:1285431973
Name:PIERCE, KELBY
Entity type:Individual
Prefix:
First Name:KELBY
Middle Name:
Last Name:PIERCE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 E PARK ST TRLR 8
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6469
Mailing Address - Country:US
Mailing Address - Phone:402-957-6286
Mailing Address - Fax:
Practice Address - Street 1:2727 W 2ND ST STE 215
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-4683
Practice Address - Country:US
Practice Address - Phone:402-334-9680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant