Healthcare Provider Details

I. General information

NPI: 1093634099
Provider Name (Legal Business Name): BLOOM IN MINDFUL BALANCE PSYCHIATRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 W CENTER RD STE 100
OMAHA NE
68144-4440
US

IV. Provider business mailing address

11602 W CENTER RD STE 100
OMAHA NE
68144-4440
US

V. Phone/Fax

Practice location:
  • Phone: 402-526-3751
  • Fax: 402-702-1518
Mailing address:
  • Phone: 402-526-3751
  • Fax: 402-702-1518

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHERRI TAYLOR
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 402-526-3751