Active NPI
Kelly Suzanne Nelson, PT, PCS
- Physical Therapist
- Omaha, NE
National Provider Identifier
1174787014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2101
- Practice address
- 16910 Frances St
Ste. 102
Omaha, NE 68130-2399 - Phone
- (402) 932-3355
- Fax
- (402) 932-3370
- NPI assigned
- Jul 10, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 2101 | NE | Primary |
Addresses
Primary practice location
16910 Frances St
Ste. 102
Omaha, NE 68130-2399
Mailing address
16910 Frances St. Ste. 102
Creighton Pediatric Therapy
Omaha, NE 68130
Phone (402) 932-3355
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47693 | Other | NE | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2101 | NE | MD | Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Creighton University | Past | Accepting new patients |
Organizations & group practices 1
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 Pharmacy
- Omaha, NE
- NPI 1477547347
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215648000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331683200000",
"number": "1174787014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16910 FRANCES ST. STE. 102",
"address_2": "CREIGHTON PEDIATRIC THERAPY",
"city": "OMAHA",
"state": "NE",
"postal_code": "68130",
"telephone_number": "402-932-3355",
"fax_number": "402-932-3370"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16910 FRANCES ST",
"address_2": "STE. 102",
"city": "OMAHA",
"state": "NE",
"postal_code": "681302399",
"telephone_number": "402-932-3355",
"fax_number": "402-932-3370"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NELSON",
"first_name": "KELLY",
"middle_name": "SUZANNE",
"credential": "PT, PCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-07-10",
"last_updated": "2012-03-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NE",
"license": "2101",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "47693",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.