Healthcare Provider Details

I. General information

NPI: 1861805111
Provider Name (Legal Business Name): JAMI KEZEOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 11/14/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 W. FAIDLEY AVE
GRAND ISLAND NE
68803
US

IV. Provider business mailing address

17445 ARBOR STREET SUITE 310
OMAHA NE
68130
US

V. Phone/Fax

Practice location:
  • Phone: 308-398-5450
  • Fax: 308-398-5351
Mailing address:
  • Phone: 531-444-1206
  • Fax: 402-445-7033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number111661
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number62280
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: