Provider Demographics
NPI:1043498314
Name:AHLERS, JEANA KAY (PA-C)
Entity type:Individual
Prefix:MS
First Name:JEANA
Middle Name:KAY
Last Name:AHLERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:JEANA
Other - Middle Name:KAY
Other - Last Name:SIMONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:305 N 37TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3275
Mailing Address - Country:US
Mailing Address - Phone:402-370-4100
Mailing Address - Fax:402-370-4101
Practice Address - Street 1:305 N 37TH ST
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-3275
Practice Address - Country:US
Practice Address - Phone:402-370-4100
Practice Address - Fax:402-370-4101
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1372363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NENA1959003Medicare PIN