Healthcare Provider Details

I. General information

NPI: 1255243036
Provider Name (Legal Business Name): AMANDA KAY TYMA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 FORT CROOK RD N
BELLEVUE NE
68005-4558
US

IV. Provider business mailing address

2323 S 171ST ST STE 100
OMAHA NE
68130-4651
US

V. Phone/Fax

Practice location:
  • Phone: 402-933-0800
  • Fax:
Mailing address:
  • Phone: 531-710-4063
  • Fax: 531-721-2918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number117196
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: