MEDICARE: TROY FENTRESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	376J00000X	Homemaker

General Provider Information

NPI Number	:	1073465407
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TROY FENTRESS

Provider Business Mailing Address
First Line	:	1299 FARNAM ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68102-1880
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4932 CALIFORNIA ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-2418
Country	:	US
Telephone Number	:	531-366-4711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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Directions to “ TROY FENTRESS ” Practice Location

Language	Start Address	Practice Location

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