Healthcare Provider Details

I. General information

NPI: 1902904576
Provider Name (Legal Business Name): JOEL ROBERT ATCHISON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 12/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3712 28TH AVENUE
KEARNEY NE
68845
US

IV. Provider business mailing address

816 22ND AVE SUITE 100
KEARNEY NE
68845-2226
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2737
  • Fax: 308-865-6098
Mailing address:
  • Phone: 308-865-2263
  • Fax: 308-865-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number20766
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: