Healthcare Provider Details

I. General information

NPI: 1790401891
Provider Name (Legal Business Name): ALEXA KELLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14537 FRANKLIN ST
OMAHA NE
68154-4709
US

IV. Provider business mailing address

14537 FRANKLIN ST
OMAHA NE
68154-4709
US

V. Phone/Fax

Practice location:
  • Phone: 402-218-9189
  • Fax:
Mailing address:
  • Phone: 402-218-9189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4494
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: