Individual
MRS. KELLY JO SHADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
R.N.,L.M.H.P.
Contact information
Practice address
5205 2ND AVE, KEARNEY, NE 68847-2471
(308) 236-7545
(308) 236-7545
Mailing address
5205 2ND AVE, KEARNEY, NE 68847-2471
(308) 236-7545
(308) 236-7545
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
423
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25690
MIDLANDS CHOICE
NE
01
—
84306
BLUE CROSS BLUE SHIELD
NE
Enumeration date
02/12/2007
Last updated
07/08/2007
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