Active NPI
Mikayla K Grevengoed, PA
- Physician Assistant
- Omaha, NE
National Provider Identifier
1215568175
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 2429
- Practice address
- 8200 Dodge St
Omaha, NE 68114 - Phone
- (402) 955-5400
- Fax
- (402) 955-4364
- NPI assigned
- Jan 30, 2020
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 115612 | IA | |
| Medical Physician Assistant | 363AM0700X | 2429 | NE | |
| Physician Assistant | 363A00000X | 2429 | NE | Primary |
Addresses
Primary practice location
8200 Dodge St
Omaha, NE 68114
Mailing address
PO Box 24607
Omaha, NE 68124
Phone (402) 955-5400
Other names 1
- Mikayla K Locke
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
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2429 | NE | MD | Occupational Therapist |
| 115612 | IA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1580342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683936000000",
"number": "1215568175",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 24607",
"city": "OMAHA",
"state": "NE",
"postal_code": "68124",
"telephone_number": "402-955-5400",
"fax_number": "402-955-3674"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8200 DODGE ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "68114",
"telephone_number": "402-955-5400",
"fax_number": "402-955-4364"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREVENGOED",
"first_name": "MIKAYLA",
"middle_name": "K",
"name_prefix": "Mrs.",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-01-30",
"last_updated": "2023-05-13",
"certification_date": "2023-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "IA",
"license": "115612",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "NE",
"license": "2429",
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NE",
"license": "2429",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MIKAYLA",
"last_name": "LOCKE",
"middle_name": "K",
"credential": "PA",
"code": "1",
"type": "Former Name"
}
]
}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 May 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.