MEDICARE: KARIE JERNSTROM PLMHP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1083596399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARIE JERNSTROM PLMHP

Provider Business Mailing Address
First Line	:	4409 VINTON ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68105-3847
Country	:	US
Telephone Number	:	913-620-2356
Fax Number	:

Provider Business Practice Location Address
First Line	:	4409 VINTON ST STE 106
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68105-3847
Country	:	US
Telephone Number	:	402-916-4545
Fax Number	:	531-213-4131

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2025
Last Update Date	:	07/25/2025

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