Healthcare Provider Details

I. General information

NPI: 1912823493
Provider Name (Legal Business Name): MICHELLE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1709 W 39TH ST
KEARNEY NE
68845-8230
US

IV. Provider business mailing address

602 LOGAN ST APT 4
HOLDREGE NE
68949-2470
US

V. Phone/Fax

Practice location:
  • Phone: 308-234-6834
  • Fax:
Mailing address:
  • Phone: 308-991-3351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: