Healthcare Provider Details

I. General information

NPI: 1972027977
Provider Name (Legal Business Name): FCN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 08/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 2ND AVE
KEARNEY NE
68847-4416
US

IV. Provider business mailing address

2605 2ND AVE
KEARNEY NE
68847-4416
US

V. Phone/Fax

Practice location:
  • Phone: 308-236-7016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PETER CRANE
Title or Position: OWNER/PROVIDER
Credential: PA-C
Phone: 402-745-6279