Healthcare Provider Details

I. General information

NPI: 1972439768
Provider Name (Legal Business Name): KEALYN ENSMINGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2026
Last Update Date: 06/20/2026
Certification Date: 06/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 RY MILLER RD
HOMER NE
68030-3546
US

IV. Provider business mailing address

104 S 5TH ST
HOMER NE
68030-3516
US

V. Phone/Fax

Practice location:
  • Phone: 712-389-6752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: