Provider Demographics
NPI:1053181479
Name:KIMNACH, PEYTON
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:
Last Name:KIMNACH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6903 OAK PLZ APT 610
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-3430
Mailing Address - Country:US
Mailing Address - Phone:402-618-3195
Mailing Address - Fax:
Practice Address - Street 1:1649 61ST ST # 301
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-2110
Practice Address - Country:US
Practice Address - Phone:402-252-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician