Healthcare Provider Details

I. General information

NPI: 1629947452
Provider Name (Legal Business Name): ASHLEY LYNN TYLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2025
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 N 72ND ST
OMAHA NE
68122-1709
US

IV. Provider business mailing address

4911 S 190TH ST
OMAHA NE
68135-3558
US

V. Phone/Fax

Practice location:
  • Phone: 402-572-2121
  • Fax:
Mailing address:
  • Phone: 308-940-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberH187774
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: