Healthcare Provider Details

I. General information

NPI: 1396218996
Provider Name (Legal Business Name): KYLEE SUE FITCH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLEE SUE DOUGLAS

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2725 S 144TH ST STE 212
OMAHA NE
68144-5253
US

IV. Provider business mailing address

2725 S 144TH ST STE 212
OMAHA NE
68144-5253
US

V. Phone/Fax

Practice location:
  • Phone: 402-609-3000
  • Fax: 402-609-3808
Mailing address:
  • Phone: 402-609-3000
  • Fax: 402-609-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number112686
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: