NPIMap

Organization Active NPI

Psychnebraska LLC

Doing business as PsychNebraska

  • Psychiatric/Mental Health Nurse Practitioner
  • Elkhorn, NE
National Provider Identifier
1023873577
Registry record updated Sep 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
Legal business name
PSYCHNEBRASKA LLC
Doing business as
PsychNebraska
Practice address
18651 Webster Cir
Elkhorn, NE 68022-3948
Phone
(531) 272-8322
Fax
(531) 272-8823
NPI assigned
Feb 14, 2024
Last updated
Sep 18, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Paul M Wilken, PMHNP-BCNPI 1427579374
Title
President
Phone
(531) 272-8322

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Care Agency 251J00000X NU
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU Primary
Community/Behavioral Health Agency 251S00000X NU

Addresses

Primary practice location

18651 Webster Cir
Elkhorn, NE 68022-3948

Mailing address

18651 Webster Cir
Elkhorn, NE 68022-3948
Phone (531) 272-8322

Other practice location 1

111 N 181st St Ste 204
Elkhorn, NE 68022-4735
Phone (531) 272-8322

Other names 1

  • PsychNebraska Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241016000530 NE Part B Supplier - Clinic/Group Practice 7911439930 Receives reassigned benefits from 4 practitioners
Practice locations: Elkhorn, NE

National Provider Directory

National Provider Directory

Locations

111 N 181st St
Ste 204
Elkhorn, NE 68022
Phone (531) 272-8322

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1707868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726617600000",
    "number": "1023873577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18651 WEBSTER CIR",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680223948",
            "telephone_number": "531-272-8322",
            "fax_number": "531-272-8823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18651 WEBSTER CIR",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680223948",
            "telephone_number": "531-272-8322",
            "fax_number": "531-272-8823"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 N 181st St Ste 204",
            "address_purpose": "LOCATION",
            "city": "Elkhorn",
            "state": "NE",
            "postal_code": "680224735",
            "country_code": "US",
            "telephone_number": "531-272-8322",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PSYCHNEBRASKA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-14",
        "last_updated": "2024-09-18",
        "certification_date": "2024-09-18",
        "status": "A",
        "authorized_official_last_name": "WILKEN",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "531-272-8322",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PMHNP-BC"
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PsychNebraska",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PsychNebraska",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkhorn, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.