Provider Demographics
NPI:1962695585
Name:BORMAN, KATHRYN S (DO, MPH)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:BORMAN
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S 70TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2451
Mailing Address - Country:US
Mailing Address - Phone:402-486-7823
Mailing Address - Fax:402-486-7872
Practice Address - Street 1:600 S 70TH ST
Practice Address - Street 2:VA MEDICAL CENTER
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2451
Practice Address - Country:US
Practice Address - Phone:402-486-7823
Practice Address - Fax:402-486-7872
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD84792084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry