Healthcare Provider Details

I. General information

NPI: 1578478525
Provider Name (Legal Business Name): LATISHA EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2026
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7734 S 159TH ST
OMAHA NE
68136-3193
US

IV. Provider business mailing address

3206 CORNHUSKER DR
OMAHA NE
68124-3019
US

V. Phone/Fax

Practice location:
  • Phone: 402-201-3183
  • Fax:
Mailing address:
  • Phone: 402-201-3183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: