Provider Demographics
NPI:1780607556
Name:BURKHART, JODENE THOMAS (ARNP-C)
Entity type:Individual
Prefix:
First Name:JODENE
Middle Name:THOMAS
Last Name:BURKHART
Suffix:
Gender:F
Credentials:ARNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3350 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GERING
Mailing Address - State:NE
Mailing Address - Zip Code:69341-1724
Mailing Address - Country:US
Mailing Address - Phone:308-635-3089
Mailing Address - Fax:308-635-0264
Practice Address - Street 1:3350 10TH ST
Practice Address - Street 2:
Practice Address - City:GERING
Practice Address - State:NE
Practice Address - Zip Code:69341-1724
Practice Address - Country:US
Practice Address - Phone:308-635-3089
Practice Address - Fax:308-635-0264
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110177363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P13377OtherUPIN
NE47049359410Medicaid
NE47049359410Medicaid