Healthcare Provider Details

I. General information

NPI: 1922793306
Provider Name (Legal Business Name): KYLE PRISBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 DODGE ST
OMAHA NE
68114-4113
US

IV. Provider business mailing address

8200 DODGE ST
OMAHA NE
68114-4113
US

V. Phone/Fax

Practice location:
  • Phone: 402-955-5142
  • Fax: 402-955-5125
Mailing address:
  • Phone: 402-955-5142
  • Fax: 402-955-5125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number37313
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: