Healthcare Provider Details

I. General information

NPI: 1740263912
Provider Name (Legal Business Name): BRENDIE ELLISON APRN-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2908 W 39TH ST STE B
KEARNEY NE
68845-1245
US

IV. Provider business mailing address

5904 R AVE
KEARNEY NE
68847-2329
US

V. Phone/Fax

Practice location:
  • Phone: 308-237-0391
  • Fax: 308-708-7452
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number110656
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: