Individual
KERRY L TAKEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
8074 S 84TH ST, LA VISTA, NE 68128-3303
(402) 779-7207
(402) 779-7210
Mailing address
8074 S 84TH ST, LA VISTA, NE 68128-3303
(402) 779-7207
(402) 779-7210
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
114804
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10028073900
—
NE
Enumeration date
06/06/2023
Last updated
03/13/2025
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