Healthcare Provider Details

I. General information

NPI: 1780607556
Provider Name (Legal Business Name): JODENE THOMAS BURKHART ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 10TH ST
GERING NE
69341-1724
US

IV. Provider business mailing address

3350 10TH ST
GERING NE
69341-1724
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-3089
  • Fax: 308-635-0264
Mailing address:
  • Phone: 308-635-3089
  • Fax: 308-635-0264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number110177
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: