Jerry Norman Bockoven
Individual provider Active NPI Clinical Psychologist · Lincoln, NE
NPI 1609932649 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1609932649
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 270 (NE)
- Practice address
- 5350 South St
Lincoln, NE 68506-2131 - Phone
- (402) 484-0595
- Fax
- (402) 484-6306
- NPI assigned
- Dec 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 270 | NE | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lock PC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 270 | NE | Yes |
Addresses
Primary practice location
5350 South St
Lincoln, NE 68506-2131
Mailing address
5350 South St
Lincoln, NE 68506-2131
Phone (402) 484-0595
Other providers in Lincoln, NE
- James A Bobenhouse
- Alexis Bock
- Cason Terryl Bock
- Heather Bock
- Janet Mae Bock
- Ma. Jolene Bockoven
- Linda D Bode
- Peyton K Bodemann
- Lexy Bodfield
- Debra Lynn Bodtke
All providers in Lincoln, NE · Clinical Psychologist in Nebraska
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.