| Keen Minds LLC | |
|
4905 S 107th Ave Omaha NE 68127-1965 | |
| (402) 819-1823 | |
| Not Available |
| Full Name | Keen Minds LLC |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 4905 S 107th Ave, Omaha, Nebraska |
| Authorized Official Name and Position | Trisha Humphrey (ACCOUNT MANAGER) |
| Authorized Official Contact | 4025044680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Keen Minds LLC 16101 Grebe St Bennington NE 68007-1255 Ph: (402) 517-0839 | Keen Minds LLC 4905 S 107th Ave Omaha NE 68127-1965 Ph: (402) 819-1823 |
| NPI Number | 1568048726 |
|---|---|
| Provider Enumeration Date | 03/19/2021 |
| Last Update Date | 08/26/2022 |
| Certification Date | 08/26/2022 |
| Medicare PECOS PAC ID | 9032518717 |
|---|---|
| Medicare Enrollment ID | O20210528002252 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568048726 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | () | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | () | Primary |
| Provider Name | Date K Amouzou |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942755954 PECOS PAC ID: 7719267046 Enrollment ID: I20161202001757 |
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