Provider Demographics
NPI:1326600271
Name:HERLEY, JODY ANN (APRN-FNP)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:ANN
Last Name:HERLEY
Suffix:
Gender:F
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 KINGS WAY
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3301
Mailing Address - Country:US
Mailing Address - Phone:402-992-1785
Mailing Address - Fax:
Practice Address - Street 1:111 KINGS WAY
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3301
Practice Address - Country:US
Practice Address - Phone:402-992-1785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE112806363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE112806OtherSTATE OF NEBRASKA