Healthcare Provider Details

I. General information

NPI: 1194451377
Provider Name (Legal Business Name): KYLE T GINNATY PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2022
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 WEST CENTER RD
OMAHA NE
68106-2714
US

IV. Provider business mailing address

7100 WEST CENTER RD
OMAHA NE
68106-2714
US

V. Phone/Fax

Practice location:
  • Phone: 402-506-9000
  • Fax: 402-506-9093
Mailing address:
  • Phone: 402-506-9000
  • Fax: 402-506-9093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3072
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: