Healthcare Provider Details

I. General information

NPI: 1154874329
Provider Name (Legal Business Name): JESSICA ALLISON LEVY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 S 27TH ST STE 201
LINCOLN NE
68512-4872
US

IV. Provider business mailing address

6825 S 27TH ST STE 201
LINCOLN NE
68512-4872
US

V. Phone/Fax

Practice location:
  • Phone: 402-434-5235
  • Fax: 402-489-2137
Mailing address:
  • Phone: 402-434-5235
  • Fax: 402-489-2137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number112067
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN290045
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: