Healthcare Provider Details

I. General information

NPI: 1104432863
Provider Name (Legal Business Name): JOCELYN TIERNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2020
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

643 FALLBROOK BLVD STE 105
LINCOLN NE
68521-9142
US

IV. Provider business mailing address

2646 W GARFIELD ST
LINCOLN NE
68522-4448
US

V. Phone/Fax

Practice location:
  • Phone: 402-276-5160
  • Fax:
Mailing address:
  • Phone: 402-276-5160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number116784
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2023
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: