Provider Demographics
NPI:1821020512
Name:JESPERSEN, AMY K (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:K
Last Name:JESPERSEN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4200 DOUGLAS STREET
Mailing Address - Street 2:CLARKSON FAMILY MEDICINE
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:CLARKSON FAMILY MEDICINE
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:2006-07-06
Last Update Date:2014-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE19192207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE91185843341Medicaid
NE91185843341Medicaid
NE270580Medicare PIN