Healthcare Provider Details

I. General information

NPI: 1063327054
Provider Name (Legal Business Name): KELLY NAHAS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5204 N 196TH ST
ELKHORN NE
68022-5241
US

IV. Provider business mailing address

5204 N 196TH ST
ELKHORN NE
68022-5241
US

V. Phone/Fax

Practice location:
  • Phone: 712-216-0362
  • Fax:
Mailing address:
  • Phone: 712-216-0362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number69317
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: