Healthcare Provider Details

I. General information

NPI: 1417873555
Provider Name (Legal Business Name): JENNIFER LYNN VINCENT PLMHP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNI VINCENT

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 W 15TH ST
KEARNEY NE
68845-6763
US

IV. Provider business mailing address

8 BRANDTS LAKEWOOD
KEARNEY NE
68845-9400
US

V. Phone/Fax

Practice location:
  • Phone: 308-236-0500
  • Fax: 308-237-5225
Mailing address:
  • Phone: 308-440-1813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number14627
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: