Individual
KEVIN K WYCOFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1021 W 14TH ST, HASTINGS, NE 68901-3046
(402) 462-8456
(402) 463-9697
Mailing address
PO BOX 968, HASTINGS, NE 68902-0968
(402) 462-8456
(402) 463-9697
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13772
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010037608
MEDICARE RAILROAD
NE
01
—
02711
NEBRASKA BCBS
NE
05
—
47061821913
—
NE
Enumeration date
08/30/2006
Last updated
01/23/2017
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