Healthcare Provider Details

I. General information

NPI: 1003729419
Provider Name (Legal Business Name): LASHAWN LYNNELL KELLOGG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2014 N 66TH ST
OMAHA NE
68104-4602
US

IV. Provider business mailing address

2014 N 66TH ST
OMAHA NE
68104-4602
US

V. Phone/Fax

Practice location:
  • Phone: 402-598-5785
  • Fax: 402-934-8462
Mailing address:
  • Phone: 402-598-5785
  • Fax: 402-934-8462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: