Provider Demographics
NPI:1497309207
Name:LOVE, JESLYNN
Entity Type:Individual
Prefix:
First Name:JESLYNN
Middle Name:
Last Name:LOVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JESLYNN
Other - Middle Name:
Other - Last Name:KEARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1686
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68848-1686
Mailing Address - Country:US
Mailing Address - Phone:308-293-1385
Mailing Address - Fax:
Practice Address - Street 1:15 W 22ND ST
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-5328
Practice Address - Country:US
Practice Address - Phone:308-236-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health