Provider Demographics
NPI:1679868301
Name:JUEDEN, KELLY JO (APRN)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:JO
Last Name:JUEDEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-2669
Mailing Address - Country:US
Mailing Address - Phone:402-316-4606
Mailing Address - Fax:402-316-3469
Practice Address - Street 1:1414 N 13TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-2669
Practice Address - Country:US
Practice Address - Phone:402-316-4606
Practice Address - Fax:402-316-3469
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE64413163W00000X
NE111223363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse