Active NPI
Amberly Catherine Wagner-Connolly, DNP, MSN, RN
- Family Nurse Practitioner
- Gretna, NE
National Provider Identifier
1093385148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 114610
- Practice address
- 11815 South 216TH Street
Gretna, NE 68028 - Phone
- (402) 659-3855
- NPI assigned
- Jun 30, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 62147 | NE | |
| Family Nurse Practitioner | 363LF0000X | 114610 | NE | Primary |
Addresses
Primary practice location
11815 South 216TH Street
Gretna, NE 68028
Mailing address
11815 South 216TH Street
Suite 6
Gretna, NE 68028
Phone (402) 659-3855
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Master of Science - Nursing, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 62147 | NE | MD | Registered Nurse |
| 114610 | NE | MD | Family Nurse Practitioner |
Interoperability endpoints
- amberly.wagner-connolly.1@24878.direct.athenahealth.com
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinic/Center
- Plattsmouth, NE
- NPI 1134694730
-
- Family Medicine Physician
- Omaha, NE
- NPI 1497051015
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1625011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1675382400000",
"number": "1093385148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11815 SOUTH 216TH STREET",
"address_2": "SUITE 6",
"city": "GRETNA",
"state": "NE",
"postal_code": "68028",
"telephone_number": "402-659-3855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11815 SOUTH 216TH STREET",
"city": "GRETNA",
"state": "NE",
"postal_code": "68028",
"telephone_number": "402-659-3855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER-CONNOLLY",
"first_name": "AMBERLY",
"middle_name": "CATHERINE",
"credential": "DNP, MSN, RN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-06-30",
"last_updated": "2023-02-03",
"certification_date": "2023-02-03",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NE",
"license": "62147",
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "NE",
"license": "114610",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gretna, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.