Healthcare Provider Details

I. General information

NPI: 1487510012
Provider Name (Legal Business Name): JAYCE TYLER CLARY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 JANE LN
LINCOLN NE
68516-2746
US

IV. Provider business mailing address

2820 JANE LN
LINCOLN NE
68516-2746
US

V. Phone/Fax

Practice location:
  • Phone: 602-499-1871
  • Fax:
Mailing address:
  • Phone: 602-499-1871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2016
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: