Healthcare Provider Details

I. General information

NPI: 1366607624
Provider Name (Legal Business Name): FERNANDO A YEPES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 CENTRAL AVE SUITE 200
KEARNEY NE
68847-2958
US

IV. Provider business mailing address

3219 CENTRAL AVE SUITE 200
KEARNEY NE
68847-2958
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-7990
  • Fax:
Mailing address:
  • Phone: 308-865-7990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number27340
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTEP5886
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: