Healthcare Provider Details

I. General information

NPI: 1467910034
Provider Name (Legal Business Name): AMANDA DELISE HUERTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7101 NEWPORT AVE
OMAHA NE
68152-2164
US

IV. Provider business mailing address

1907 E AVE
KEARNEY NE
68847-6236
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-2916
  • Fax: 402-572-2528
Mailing address:
  • Phone: 816-266-0060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number114057
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number114057
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: