Healthcare Provider Details

I. General information

NPI: 1285550855
Provider Name (Legal Business Name): KAY DEE CHAVEZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4355 DAVENPORT ST APT 2
OMAHA NE
68131-2252
US

IV. Provider business mailing address

4355 DAVENPORT ST APT 2
OMAHA NE
68131-2252
US

V. Phone/Fax

Practice location:
  • Phone: 575-639-1398
  • Fax:
Mailing address:
  • Phone: 575-639-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number305646
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: