Healthcare Provider Details

I. General information

NPI: 1588580088
Provider Name (Legal Business Name): WHITNEY L CLARK PROFESSIONAL SERVICES L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11422 MIRACLE HILLS DR STE 401
OMAHA NE
68154-4420
US

IV. Provider business mailing address

4693 PIERCE ST
OMAHA NE
68106-2031
US

V. Phone/Fax

Practice location:
  • Phone: 402-590-2590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: WHITNEY LYNN CLARK
Title or Position: OWNER
Credential: APRN, PMHNP-BC
Phone: 402-676-3354