Provider Demographics
NPI:1922474212
Name:MYERS, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:MYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 W 46TH ST
Mailing Address - Street 2:STE 106
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8348
Mailing Address - Country:US
Mailing Address - Phone:308-236-7790
Mailing Address - Fax:
Practice Address - Street 1:124 W 46TH ST
Practice Address - Street 2:STE 106
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8348
Practice Address - Country:US
Practice Address - Phone:308-236-7790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-20
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health