Healthcare Provider Details

I. General information

NPI: 1285389312
Provider Name (Legal Business Name): JENSYN E BERANEK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENSYN E MEYER PA

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 W 35TH ST STE 1
KEARNEY NE
68845-2909
US

IV. Provider business mailing address

2810 W 35TH ST STE 1
KEARNEY NE
68845-2909
US

V. Phone/Fax

Practice location:
  • Phone: 308-865-2570
  • Fax: 308-865-2508
Mailing address:
  • Phone: 308-865-2570
  • Fax: 308-865-2508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2758
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1116
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: