Organization Active NPI

Elite Health and Wellness LLC

  • Nurse Practitioner
  • Kearney, NE
National Provider Identifier
1881282937
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ELITE HEALTH AND WELLNESS LLC
Practice address
4715 2ND Ave
Kearney, NE 68847-2463
Phone
(308) 455-1500
Fax
(308) 455-1502
NPI assigned
Jan 5, 2021
Last updated
Jan 5, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

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

Authorized official

Name
Erin Stickney, NPNPI 1861775421
Title
Chief Executive Officer
Phone
(308) 455-1500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

4715 2ND Ave
Kearney, NE 68847-2463

Mailing address

2401 E Ave Unit 3077
Kearney, NE 68848-0347
Phone (308) 455-1500

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address office@elitekearney.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210209001427 NE Part B Supplier - Clinic/Group Practice 3971918715 Receives reassigned benefits from 2 practitioners
Practice locations: Kearney, NE

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
28D2214014Elite Health and Wellness LLC4715 2ND Ave, Kearney, NE 68847Certificate of waiverFeb 17, 2027

National Provider Directory

National Provider Directory

Locations

4715 2nd Ave
Kearney, NE 68847
Phone (308) 455-1500

2401 E Ave
Unit 3077
Kearney, NE 68848

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1609804800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1881282937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 E AVE UNIT 3077",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688480347",
            "telephone_number": "308-455-1500",
            "fax_number": "308-455-1502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4715 2ND AVE",
            "city": "KEARNEY",
            "state": "NE",
            "postal_code": "688472463",
            "telephone_number": "308-455-1500",
            "fax_number": "308-455-1502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-05",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A",
        "authorized_official_last_name": "STICKNEY",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "308-455-1500",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "office@elitekearney.com",
            "affiliation": "N",
            "endpointDescription": "Office Email",
            "address_1": "4715 2nd Ave",
            "city": "Kearney",
            "state": "NE",
            "country_code": "US",
            "postal_code": "688472463",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kearney, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.