Healthcare Provider Details

I. General information

NPI: 1548082761
Provider Name (Legal Business Name): KATIE NICOLE JENKINS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE
OMAHA NE
68105-1850
US

IV. Provider business mailing address

4602 HANSEN AVE
PAPILLION NE
68133-2573
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-3800
  • Fax:
Mailing address:
  • Phone: 402-917-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number68156
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: