Healthcare Provider Details

I. General information

NPI: 1215861976
Provider Name (Legal Business Name): MADISON ELIZABETH KELLY DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

983255 NEBRASKA MEDICAL CTR
OMAHA NE
68198-3255
US

IV. Provider business mailing address

983255 NEBRASKA MEDICAL CTR
OMAHA NE
68198-3255
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-4500
  • Fax: 402-559-8882
Mailing address:
  • Phone: 402-559-4500
  • Fax: 402-559-8882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10576
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: