Richard Lee Kissack

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Practice address

1811 W. 2ND St.
Suite 450
Grand Island, NE 68803-7543

Phone

(308) 379-8619

NPI assigned

Dec 23, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1640217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640217600000",
    "number": "1639839137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1811 W. 2ND ST.",
            "address_2": "SUITE 450",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688035473",
            "telephone_number": "308-379-8619",
            "fax_number": "308-675-2690"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1811 W. 2ND ST.",
            "address_2": "SUITE 450",
            "city": "GRAND ISLAND",
            "state": "NE",
            "postal_code": "688037543",
            "telephone_number": "308-379-8619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISSACK",
        "first_name": "RICHARD",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-23",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NE",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Kinney
• Breanna Kirby
• Amanda Kirkland, LPN
• Jacob Thomas Kirkpatrick, CPO
• Cynthia Lee Kissack, M.S.ED.
• Trey A Kissack
• Ben Wayne Kistler, RPH
• Melissa Kjar, PT
• Derek James Kleier, PA-C
• Chris Klein, LADC

• Community/Behavioral Health Agency in Grand Island, NE
• Providers in Grand Island, NE by specialty
• Community/Behavioral Health Agency in Nebraska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 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.

Verify at the official NPI Registry.