Provider Demographics
NPI:1861805111
Name:KEZEOR, JAMI (APRN)
Entity type:Individual
Prefix:
First Name:JAMI
Middle Name:
Last Name:KEZEOR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17445 ARBOR STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:531-444-1206
Mailing Address - Fax:402-445-7033
Practice Address - Street 1:2730 W. FAIDLEY AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803
Practice Address - Country:US
Practice Address - Phone:308-398-5450
Practice Address - Fax:308-398-5351
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE111661363L00000X
NE62280363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily