Phyllis Vance, APRN
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Lavista, NE
NPI 1003390980 · NPPES record last updated Feb 22, 2022
Key facts
- NPI
- 1003390980
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 113743 (NE)
- Practice address
- 10748 Virginia PLZ, Suite 107
Lavista, NE 68128-3265 - Phone
- (402) 933-4411
- Fax
- (888) 507-5931
- NPI assigned
- Sep 18, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Focus C3, PC
Practice addresses (Care Compare)
10748 Virginia PLZ
Suite 107
La Vista, NE 68128-3265
Phone (402) 933-4411
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211117000155 | NE | Practitioner - Nurse Practitioner | 8921351610 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Focus C3, PC | Psychiatric/Mental Health | Current |
Accepting new patients |
Locations
10748 Virginia Plz
Ste 107
Lavista, NE 68128
Phone (402) 933-4411
11069 I St
Omaha, NE 68137
Phone (402) 201-7719
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 3012687 | KY | |
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 113743 | NE | Yes |
Addresses
Primary practice location
10748 Virginia PLZ, Suite 107
Lavista, NE 68128-3265
Mailing address
10748 Virginia PLZ, Suite 107
Lavista, NE 68128-3265
Phone (402) 933-4411
Other names
- Phyllis Faulkner
Other providers in Lavista, NE
- Johannes Alvin Nhete
- Pro Health Pain & Rehab LLC.
- Michael Joseph Schilmoeller
- Summit Dental Associates
- Cara Janine Thompson
- Wal-Mart Stores, Inc.
- Sarah Catherine Wiegman
All providers in Lavista, NE · Psychiatric/Mental Health Nurse Practitioner in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 22, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.