Provider Demographics
NPI:1437048204
Name:KELLOGG, BEVERLY ANN
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANN
Last Name:KELLOGG
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8107 N 129TH ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68142-1328
Mailing Address - Country:US
Mailing Address - Phone:402-203-9839
Mailing Address - Fax:
Practice Address - Street 1:8107 N 129TH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68142-1328
Practice Address - Country:US
Practice Address - Phone:402-203-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-28
Last Update Date:2025-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE372500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider