Provider Demographics
NPI:1326117243
Name:PIKE, JOLENE ANN (APRN)
Entity Type:Individual
Prefix:MRS
First Name:JOLENE
Middle Name:ANN
Last Name:PIKE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 LINCOLN
Mailing Address - Street 2:
Mailing Address - City:BEATRICE
Mailing Address - State:NE
Mailing Address - Zip Code:68310
Mailing Address - Country:US
Mailing Address - Phone:402-223-6137
Mailing Address - Fax:402-223-7589
Practice Address - Street 1:3000 LINCOLN
Practice Address - Street 2:
Practice Address - City:BEATRICE
Practice Address - State:NE
Practice Address - Zip Code:68310
Practice Address - Country:US
Practice Address - Phone:402-223-6137
Practice Address - Fax:402-223-7589
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110368363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE110368Medicaid
P10082Medicare UPIN
272698PIMedicare ID - Type Unspecified