Provider Demographics
NPI:1831278415
Name:KETNER, JARED B (MD)
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:B
Last Name:KETNER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:SEWARD
Mailing Address - State:NE
Mailing Address - Zip Code:68434-2248
Mailing Address - Country:US
Mailing Address - Phone:402-643-4800
Mailing Address - Fax:402-646-4635
Practice Address - Street 1:250 N COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:SEWARD
Practice Address - State:NE
Practice Address - Zip Code:68434-2248
Practice Address - Country:US
Practice Address - Phone:402-643-4800
Practice Address - Fax:402-646-4635
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19878207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE8321OtherMIDLANDS CHOICE
NE0100819OtherUNITEDHEALTHCARE
NE31882OtherBCBS OF NEBRASKA
NE26865Medicare ID - Type Unspecified
NE0100819OtherUNITEDHEALTHCARE