Active NPI
Kelly Dillon
- Counselor
- Lincoln, NE
National Provider Identifier
1609324706
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 12679
- Practice address
- 4545 S 86TH St
Lincoln, NE 68526-9262 - Phone
- (402) 483-6990
- NPI assigned
- Sep 17, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | |||
| Counselor | 101Y00000X | 12679 | NE | Primary |
Addresses
Primary practice location
4545 S 86TH St
Lincoln, NE 68526-9262
Mailing address
4545 S 86TH St
Lincoln, NE 68526-9262
Phone (402) 483-6990
Other practice location 1
939 Tamarack Ave NW
Floor 2
Grand Rapids, MI 49504-4371
Phone (231) 613-2562
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 |
|---|---|---|---|
| 12679 | NE | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627516800000",
"number": "1609324706",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4545 S 86TH ST",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685269262",
"telephone_number": "402-483-6990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4545 S 86TH ST",
"city": "LINCOLN",
"state": "NE",
"postal_code": "685269262",
"telephone_number": "402-483-6990"
}
],
"practiceLocations": [
{
"address_1": "939 Tamarack Ave NW",
"address_2": "Floor 2",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495044371",
"country_code": "US",
"telephone_number": "231-613-2562",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DILLON",
"first_name": "KELLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-17",
"last_updated": "2021-07-29",
"certification_date": "2021-07-29",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "NE",
"license": "12679",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lincoln, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.