Healthcare Provider Details

I. General information

NPI: 1417865056
Provider Name (Legal Business Name): ABBY KERKMAN
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 W 2ND ST STE LL200
GRAND ISLAND NE
68803-5420
US

IV. Provider business mailing address

1811 W 2ND ST STE LL200
GRAND ISLAND NE
68803-5420
US

V. Phone/Fax

Practice location:
  • Phone: 308-382-1884
  • Fax: 308-382-1884
Mailing address:
  • Phone: 308-382-1884
  • Fax: 308-382-1884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number28865
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: