Healthcare Provider Details

I. General information

NPI: 1235058850
Provider Name (Legal Business Name): KENNET CHRISTOPHER SORENSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 S 42ND STREET
OMAHA NE
68131
US

IV. Provider business mailing address

985575 NEBRASKA MEDICAL CTR
OMAHA NE
68198-5575
US

V. Phone/Fax

Practice location:
  • Phone: 402-552-6007
  • Fax:
Mailing address:
  • Phone: 404-660-0070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number10689
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: