Healthcare Provider Details

I. General information

NPI: 1962201046
Provider Name (Legal Business Name): MCKAYLA IRVIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12875 DEAUVILLE DR
OMAHA NE
68137-3242
US

IV. Provider business mailing address

16412 BIRCH AVE
OMAHA NE
68136-3225
US

V. Phone/Fax

Practice location:
  • Phone: 402-399-1700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number85434
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: