Healthcare Provider Details

I. General information

NPI: 1912835141
Provider Name (Legal Business Name): KAYLIE HUNTLEY APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2026
Last Update Date: 05/09/2026
Certification Date: 05/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 S 51ST ST UNIT 6005
OMAHA NE
68106-2406
US

IV. Provider business mailing address

1718 S 51ST ST UNIT 6005
OMAHA NE
68106-2406
US

V. Phone/Fax

Practice location:
  • Phone: 712-310-4752
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number116219
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: