Provider Demographics
NPI:1689606642
Name:AUTHIER, JERRY L (PHD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:AUTHIER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 DOUGLAS STREET
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-2700
Mailing Address - Country:US
Mailing Address - Phone:402-552-3222
Mailing Address - Fax:402-552-2172
Practice Address - Street 1:4200 DOUGLAS STREET
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68131-2700
Practice Address - Country:US
Practice Address - Phone:402-552-3222
Practice Address - Fax:402-552-2172
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA91185843329Medicaid
IA269324Medicare ID - Type Unspecified
IA090855AUMedicare UPIN