Individual provider Active NPI

Debra L Kellberg, APRN

  • Critical Care Neonatal Nurse Practitioner
  • Elkhorn, NE
National Provider Identifier
1811100126
Registry record updated Sep 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Neonatal Nurse PractitionerTaxonomy code 363LN0005X
License
110561 Issued in NE
Practice address
707 N 190TH PLZ
Elkhorn, NE 68022-3974
Phone
(402) 815-6428
Fax
(402) 815-1565
NPI assigned
May 7, 2007
Last updated
Sep 18, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Neonatal Nurse Practitioner 363LN0005X 110561 NE Primary

Addresses

Primary practice location

707 N 190TH PLZ
Elkhorn, NE 68022-3974

Mailing address

PO Box 2797
Omaha, NE 68103-2797
Phone (402) 354-4230

Other identifiers 2

IdentifierTypeStateIssuer
100258661-00MedicaidNE
1811100126MedicaidIA

Other names 1

  • Ms. Debra L Deppe Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100721000813 NE Practitioner - Nurse Practitioner 6901938240 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Nebraska Methodist Hospital CurrentSince Jun 21, 2010 Accepting new patients
Bryan Physician Network Past Accepting new patients

Locations

707 N 190th Plz
Elkhorn, NE 68022
Phone (402) 354-4000

8303 Dodge St
Ste LL6
Omaha, NE 68114
Phone (402) 354-4104

8601 W Dodge Rd
Ste 216
Omaha, NE 68114
Phone (402) 354-4822

Interoperability endpoints

  • Direct secure messaging: dkellberg13527@hisp.bryanhealth.org

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410998400000",
    "number": "1811100126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2797",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681032797",
            "telephone_number": "402-354-4230",
            "fax_number": "402-354-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N 190TH PLZ",
            "city": "ELKHORN",
            "state": "NE",
            "postal_code": "680223974",
            "telephone_number": "402-815-6428",
            "fax_number": "402-815-1565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLBERG",
        "first_name": "DEBRA",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-07",
        "last_updated": "2014-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "NE",
            "license": "110561",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100258661-00",
            "state": "NE"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811100126",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEBRA",
            "last_name": "DEPPE",
            "middle_name": "L",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elkhorn, NE

Sources for this page

Verify at the official NPI Registry.