Provider Demographics
NPI:1306920152
Name:PSOTA, DEANN K (MD)
Entity type:Individual
Prefix:
First Name:DEANN
Middle Name:K
Last Name:PSOTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W 33RD ST
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845-3484
Mailing Address - Country:US
Mailing Address - Phone:308-865-2141
Mailing Address - Fax:308-234-7582
Practice Address - Street 1:211 WEST 33RD STREET
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68845
Practice Address - Country:US
Practice Address - Phone:308-865-2141
Practice Address - Fax:308-234-7582
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47064194537Medicaid
06456OtherBCBS
F37293Medicare UPIN
260944Medicare ID - Type Unspecified