# BELLEVUE PRIMARY HEALTHCARE PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497091888
- **Authorized official:** MRS. KELLI RAE PAVLISH APRN (NURSE PRACTITIONER)
- **Authorized official phone:** (402) 525-6976

## Contact information

- **Practice address:** 12717 S 28TH AVE, BELLEVUE, NE 68123-3232
- **Practice address phone:** (402) 525-6976
- **Mailing address:** 703 CANYON RD, BELLEVUE, NE 68005-2735
- **Mailing address phone:** (402) 525-6976

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 261QP2300X | Primary Care Clinic/Center | 111265 | NE | — |

## Other

- **Enumeration date:** 12/12/2012
- **Last updated:** 04/24/2024