Provider Demographics
NPI:1992517627
Name:PETERSON, KAYLA CHRISTINA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:CHRISTINA
Last Name:PETERSON
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 1:8245 NORTHWOODS DR APT 210
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-3013
Mailing Address - Country:US
Mailing Address - Phone:308-529-0717
Mailing Address - Fax:
Practice Address - Street 1:5600 S 48TH ST STE 118
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-4110
Practice Address - Country:US
Practice Address - Phone:402-474-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion