Provider Demographics
NPI:1699884445
Name:MARTIN, KATHLEEN HUNT (MS)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:HUNT
Last Name:MARTIN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:ELAINE
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSN
Mailing Address - Street 1:11920 BURT STREET
Mailing Address - Street 2:SUITE 190
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154
Mailing Address - Country:US
Mailing Address - Phone:402-965-4004
Mailing Address - Fax:402-965-4232
Practice Address - Street 1:11920 BURT STREET
Practice Address - Street 2:SUITE 190
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154
Practice Address - Country:US
Practice Address - Phone:402-965-4004
Practice Address - Fax:402-965-4232
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1461101YM0800X
NE930101YP2500X
NE39376163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025086600Medicaid
NE84077OtherBCBS