Healthcare Provider Details

I. General information

NPI: 1902729809
Provider Name (Legal Business Name): AMARI L POWELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15005 JAYNES ST
OMAHA NE
68116-4395
US

IV. Provider business mailing address

15005 JAYNES ST
OMAHA NE
68116-4395
US

V. Phone/Fax

Practice location:
  • Phone: 402-301-4567
  • Fax:
Mailing address:
  • Phone: 402-301-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberH13823688
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: