Active NPI
Kim Mikos
- Speech-Language Pathologist
- Gretna, NE
National Provider Identifier
1811363765
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 667
- Practice address
- 11221 Northridge Dr
Gretna, NE 68028-6935 - Phone
- (402) 332-5578
- NPI assigned
- Aug 14, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 667 | NE | Primary |
Addresses
Primary practice location
11221 Northridge Dr
Gretna, NE 68028-6935
Mailing address
20003 Maple St
Gretna, NE 68028-4367
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 |
|---|---|---|---|
| 667 | NE | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439510400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439510400000",
"number": "1811363765",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20003 MAPLE ST",
"city": "GRETNA",
"state": "NE",
"postal_code": "680284367"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11221 NORTHRIDGE DR",
"city": "GRETNA",
"state": "NE",
"postal_code": "680286935",
"telephone_number": "402-332-5578"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKOS",
"first_name": "KIM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-08-14",
"last_updated": "2015-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "NE",
"license": "667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gretna, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.