Healthcare Provider Details

I. General information

NPI: 1881100816
Provider Name (Legal Business Name): CARISSA NESBIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARISSA VAN NORMAN

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 S 193RD AVE
OMAHA NE
68135-3947
US

IV. Provider business mailing address

6420 S 193RD AVE
OMAHA NE
68135-3947
US

V. Phone/Fax

Practice location:
  • Phone: 402-534-1486
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number0097
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: