Provider Demographics
NPI:1801064878
Name:DICKE, KAYLA M (PA-C)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:DICKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KAYLA
Other - Middle Name:MARIE
Other - Last Name:KAPELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4508 38TH ST
Mailing Address - Street 2:SUITE #152
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-1668
Mailing Address - Country:US
Mailing Address - Phone:402-563-4500
Mailing Address - Fax:402-563-3520
Practice Address - Street 1:4508 38TH ST
Practice Address - Street 2:SUITE #152
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1668
Practice Address - Country:US
Practice Address - Phone:402-563-4500
Practice Address - Fax:402-563-3520
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1377363AS0400X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025979300Medicaid
NE37454OtherBLUE CROSS OF NEBRASKA
NE1538141593Medicaid
NE061181648-68601-A004OtherTRIWEST
NE255449OtherMIDLANDS CHOICE PPO
NE255449OtherMIDLANDS CHOICE PPO