Healthcare Provider Details

I. General information

NPI: 1376403030
Provider Name (Legal Business Name): JESSICA JO SIDWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2025
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9239 W CENTER RD
OMAHA NE
68124-1933
US

IV. Provider business mailing address

1805 GREYSON DR
PAPILLION NE
68133-2477
US

V. Phone/Fax

Practice location:
  • Phone: 402-399-8888
  • Fax: 855-218-7222
Mailing address:
  • Phone: 402-943-8217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number93545
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: