Healthcare Provider Details

I. General information

NPI: 1679419634
Provider Name (Legal Business Name): WHITNEY L CLARK APRN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
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 Number116501
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: