Provider Demographics
NPI:1568269249
Name:LARA, JENTRI SHEA
Entity type:Individual
Prefix:
First Name:JENTRI
Middle Name:SHEA
Last Name:LARA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3423 2ND AVE STE 1A
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-2947
Mailing Address - Country:US
Mailing Address - Phone:308-663-3828
Mailing Address - Fax:
Practice Address - Street 1:820 S PINE AVE TRLR 218
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-7059
Practice Address - Country:US
Practice Address - Phone:308-528-2753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372600000XNursing Service Related ProvidersAdult Companion