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General NPI Number Information
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NPI Number | 1285927608
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Entity Type | Individual
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Provider Name | JENNA N. DERR M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2011
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Last Update Date | 04/03/2023
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Provider Practice Location Address
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Address Line | 218 W 39TH ST
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City | KEARNEY
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State | NE
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Zip | 68845-2802
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Country | US
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Telephone | 308-251-7474
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Fax |
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Provider Business Mailing Address
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Address Line | 218 W 39TH ST
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City | KEARNEY
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State | NE
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Zip | 68845-2802
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Country | US
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Telephone | 308-251-7474
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 62853-20
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 26959
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License Number State | NE
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