Healthcare Provider Details

I. General information

NPI: 1164362570
Provider Name (Legal Business Name): BRANDON KEA RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 FARNAM ST
OMAHA NE
68131-2806
US

IV. Provider business mailing address

130 CHARLES ST
COUNCIL BLUFFS IA
51503-4961
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number169130
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: