Healthcare Provider Details

I. General information

NPI: 1932930575
Provider Name (Legal Business Name): ANDREA B KENNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E MILITARY AVE STE 212
FREMONT NE
68025-5433
US

IV. Provider business mailing address

12125 OHERN ST
OMAHA NE
68137-2116
US

V. Phone/Fax

Practice location:
  • Phone: 402-249-3624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1713
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4600
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: