Healthcare Provider Details

I. General information

NPI: 1326499088
Provider Name (Legal Business Name): SEAN KELLY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2016
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

987400 NEBRASKA MEDICAL CTR
OMAHA NE
68198-7400
US

IV. Provider business mailing address

11560 S 124TH ST
PAPILLION NE
68046-5924
US

V. Phone/Fax

Practice location:
  • Phone: 402-559-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License Number33973
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: