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General NPI Number Information
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NPI Number | 1104709005
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Entity Type | Individual
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Provider Name | ANDREW HERNANDEZ
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Gender | Male
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Dates
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Enumeration Date | 07/28/2025
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Last Update Date | 07/28/2025
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Provider Practice Location Address
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Address Line | 1755 PRAIRIE VIEW PL
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City | KEARNEY
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State | NE
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Zip | 68845-8300
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Country | US
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Telephone | 308-865-2249
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Fax |
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Provider Business Mailing Address
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Address Line | 103 E 18TH ST
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City | GRAND ISLAND
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State | NE
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Zip | 68801-2303
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Country | US
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Telephone | 562-385-3282
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 116085
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License Number State | NE
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