Healthcare Provider Details

I. General information

NPI: 1912829227
Provider Name (Legal Business Name): BRIANA T CARNICLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S 48TH ST
LINCOLN NE
68506-1299
US

IV. Provider business mailing address

6720 SW 4TH ST APT 108
LINCOLN NE
68523-9166
US

V. Phone/Fax

Practice location:
  • Phone: 402-481-1111
  • Fax:
Mailing address:
  • Phone: 402-840-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number3493
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3493
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: