Provider Demographics
NPI:1992882229
Name:FISCHER POTTS, KELLY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:FISCHER POTTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 SW 17TH ST.
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68523-9200
Mailing Address - Country:US
Mailing Address - Phone:402-499-4108
Mailing Address - Fax:
Practice Address - Street 1:535 FORTUNE DR STE 150
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-3428
Practice Address - Country:US
Practice Address - Phone:402-499-4108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE607103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025483900Medicaid
NE10025483900Medicaid