Provider Demographics
NPI:1689483703
Name:GAMMEL, KELLY KRISTINE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:KRISTINE
Last Name:GAMMEL
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 1:11220 BLONDO ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-3820
Mailing Address - Country:US
Mailing Address - Phone:531-299-1661
Mailing Address - Fax:531-299-1679
Practice Address - Street 1:11220 BLONDO ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68164-3820
Practice Address - Country:US
Practice Address - Phone:531-299-1661
Practice Address - Fax:531-299-1679
Is Sole Proprietor?:No
Enumeration Date:2025-01-03
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant