Provider Demographics
NPI:1750196945
Name:BRACKEN, VERN E JR
Entity type:Individual
Prefix:MR
First Name:VERN
Middle Name:E
Last Name:BRACKEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DON
Other - Middle Name:E
Other - Last Name:BRACKEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8106 N 170TH ST
Mailing Address - Street 2:
Mailing Address - City:BENNINGTON
Mailing Address - State:NE
Mailing Address - Zip Code:68007-3351
Mailing Address - Country:US
Mailing Address - Phone:402-968-5464
Mailing Address - Fax:
Practice Address - Street 1:8106 N 170TH ST
Practice Address - Street 2:
Practice Address - City:BENNINGTON
Practice Address - State:NE
Practice Address - Zip Code:68007-3351
Practice Address - Country:US
Practice Address - Phone:402-968-5464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16228613385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child